BackgroundThe relationship between psychological stress and interstitial cystitis/bladder pain syndrome (IC/BPS) has been well described. Even though there is some overlapping of symptoms between overactive bladder (OAB) and IC/BPS, there have been very few studies that specifically investigated the relationship between psychological stress and urinary symptoms in OAB patients who do not have pelvic pain. Here we examined the relationship between psychological stress levels and the severity of overactive bladder (OAB) symptoms.MethodsPatients diagnosed with OAB (n=51), IC/BPS (n=27), and age-matched healthy controls (n=30) participated in a case control study that inquired about their psychological stress levels using the perceived stress scale (PSS). PSS reported by the three patient groups were compared. Among OAB patients, their responses on the PSS was correlated to OAB symptoms using the following questionnaires: 1) international consultation on incontinence – urinary incontinence (ICIQ-UI), 2) international consultation on incontinence – overactive bladder (ICIQ-OAB), 3) OAB-q short form, 4) urogenital distress inventory (UDI-6), 5) incontinence impact questionnaire (IIQ-7), 6) urgency severity scale (USS), 7) numeric rating scales of urgency symptom, and 8) frequency symptom. Spearman’s correlation tests were performed to examine the relationship between psychological stress levels and the severity of OAB symptoms.ResultsOAB patients reported psychological stress levels that were as high as IC/BPS patients (median 17.0 versus 18.0, p=0.818, Wilcoxon sum rank test), and significantly higher than healthy controls (17.0, versus 7.5, p=0.001). Among OAB patients, there was a positive correlation between perceived stress levels and urinary incontinence symptoms (ICIQ-UI, Spearman’s correlation coefficient=0.39, p=0.007), and impacts on quality of life (UDI-6, IIQ-7, OAB-q quality of life subscale; Spearman’s correlation coefficient=0.32, 0.31, 0.39, and p=0.028, 0.005, 0.029, respectively). No significant correlation was observed between perceived stress levels and urgency or frequency symptoms (ICIQ-OAB, USS, numeric ratings of urgency and frequency).ConclusionsOAB patients reported psychological stress levels that were as high as IC/BPS patients, and significantly higher than healthy controls. There was a positive correlation between perceived stress levels and urinary incontinence symptoms, and its impacts on quality of life among OAB patients.

BackgroundTo investigate the relationship between depression and overactive bladder (OAB)/urinary incontinence symptoms among the clinical OAB population.MethodsPatients who were diagnosed with overactive bladder (OAB) and age-matched control subjects without OAB were enrolled. Depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-D). OAB/incontinence symptoms were assessed using the validated questionnaires: ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, and OAB-q.Results27.5 % of OAB patients in our study had depression (HADS ≥8), and 12 % of OAB patients had moderate to severe depression (HADS-D ≥11). OAB patients reported significantly higher HADS-D depression scores compared to age-matched controls (5.3 ± 3.9 versus 2.8 ± 3.9, p = 0.004). OAB patients with depression reported more severe incontinence symptoms (ICIQ-UI), greater bother and more impact on quality of life (UDI-6, IIQ-7) compared to OAB patients without depression (p = 0.001, 0.01, <0.001, respectively). However there were no differences in ICIQ-OAB and OAB-q. Among OAB patients, there were positive correlations between the severity of depression symptoms and OAB/incontinence symptoms (p-values <0.001 to 0.035).Conclusions27.5 % of OAB patients have depression. OAB patients with depression reported more severe urinary incontinence symptoms, greater bother and more impact on quality of life compared to those without depression. Future studies are needed to further examine the mechanistic links between depression and OAB/urinary incontinence.

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Objective To further evaluate the sensitivity and specificity of urine aquaporin-1 (AQP1) and perilipin-2 (PLIN2) concentrations to diagnose clear cell or papillary renal cell carcinoma (RCC) we compared these unique urine biomarker concentrations in patients with RCC, non-cancer renal masses, bladder cancer and prostate cancer. Patients and Methods From February 1 through October 31, 2012 pre-operative urine samples were obtained from patients with a presumptive diagnosis of RCC based on an imaged renal mass, prostate cancer or transitional cell bladder cancer. Imaged renal masses were diagnosed post-nephrectomy, as cancer or benign, by histology. Urine AQP1 and PLIN2 concentrations were measured by sensitive and specific Western blot and normalized to urine creatinine concentration. Results Median urine AQP1 and PLIN2 in patients with clear cell and papillary RCC (n=47) were 29 and 36 relative absorbance units/mg urine creatinine. In contrast, median concentrations in bladder (n=22) and prostate cancer (n=27), patients with chromophobe tumors (n=7), and in benign renal oncocytoma (n=9) and angiomyolipomas (n=7), were all less than 10 (P <.001 vs RCC for both biomarkers, Kruskal-Wallis test) and comparable to healthy controls. The area under the receiver operating characteristic curve was 0.99 to 1.00 for both biomarkers. Conclusions These results further demonstrate the specificity and sensitivity of urine AQP1 and PLIN2 concentrations for RCC. These novel tumor-specific proteins have high clinical validity and substantial potential as specific screening biomarkers for clear cell and papillary RCC, and in the differential diagnosis of imaged renal masses.

Objectives To describe the full spectrum of symptom exacerbations defined by interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome patients as flares, and to investigate their associated health-care utilization and bother at two sites of the Trans-Multidisciplinary Approaches to the Study of Chronic Pelvic Pain (Trans-MAPP) Epidemiology and Phenotyping study. Patients and methods Participants completed a flare survey that asked them: 1) whether they had ever had flares (“symptoms that are much worse than usual”) that lasted <1 hr, >1 hr and <1 day, and >1 day; and 2) for each duration of flare, to report their: a) average length and frequency; b) typical levels of urologic and pelvic pain symptoms; and c) levels of health-care utilization and bother. We compared participants' responses to their non-flare Trans-MAPP values and across flares using generalized linear mixed models. Results Seventy six of 85 participants (89.4%) completed the flare survey, 72 of whom reported having flares (94.7%). Flares varied widely in terms of their duration (seconds to months), frequency (several times per day to once per year or less), and intensity and type of symptoms (e.g., pelvic pain versus urologic symptoms). Flares of all duration were associated with greater pelvic pain, urologic symptoms, disruption to participants' activities, and bother, with increasing severity of each of these factors as the duration of flares increased. Days-long flares were also associated with greater health-care utilization. In addition to duration, symptoms (pelvic pain, in particular) were also significant determinants of flare-related bother. Conclusions Our findings suggest that flares are common and associated with greater symptoms, health-care utilization, disruption, and bother. Our findings also inform the characteristics of flares most bothersome to patients (i.e., increased pelvic pain and duration), and thus of greatest importance to consider in future research on flare prevention and treatment.

Aims (1) To describe the prevalence of childhood and recent trauma in patients with overactive bladder (OAB), and (2) assess the impact of traumatic events on the clinical presentation and the severity of OAB symptoms, quality of life, and psychosocial health. Methods Patients diagnosed with OAB (n=51) and age-matched healthy controls (n=30) were administered the Childhood Traumatic Events Scale and Recent Traumatic Events Scale, assessing exposure and perceived impact of common traumatic events. Among OAB patients, validated instruments were administered to correlate traumatic exposure to evaluate adult urinary symptoms (ICIQ-UI, ICIQ-OAB, OAB-q, UDI-6, IIQ-7, USS), mood dysregulation (HADS), sleep and fatigue (PROMIS), and psychological stress (PSS). Results Childhood sexual trauma was more prevalent in patients with OAB compared to controls (29.4% vs. 6.7%, p=0.041). OAB patients also rated their childhood sexual exposure as more traumatic compared to controls (mean ratings of 1.7 vs. 0.4, p=0.050). There was no difference in childhood deaths (p=0.24), parental upheaval (p=0.87), violence (p=0.099), illness/injury (p=0.683), or any recent traumatic events between OAB and control subjects. Childhood trauma predicted worse bladder pain (p=0.005), worse non-urologic pain (p=0.017), poorer mood (p=0.001), higher anxiety (p=0.029), higher physical symptom burden (p<0.001), and higher psychological stress (p<0.039). However, childhood trauma did not correlate with the severity of OAB symptoms (urgency, frequency, incontinence). Conclusions 30% of OAB patients reported childhood sexual trauma. These patients report more pain symptoms, poorer mood, and greater somatic burden. These data highlight the potentiating role of psychosocial stressors from childhood in the adult suffering from OAB.

Objective To investigate the relationship between anxiety and overactive bladder/urinary incontinence symptoms among clinical population. Methods Patients who were diagnosed with overactive bladder (OAB) and age-matched control subjects without OAB were enrolled. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-A). OAB/incontinence symptoms were assessed using the ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, and OAB-q. Other psychosocial factors were also assessed. Results About half of the OAB subjects (48%) had anxiety symptoms, and one quarter of OAB subjects (24%) had moderate to severe anxiety. OAB subjects reported significantly higher anxiety symptoms compared to age-matched controls (HADS-A: 7.5 ± 4.5 versus 3.3 ± 3.6, p<0.001). OAB subjects with anxiety reported more severe OAB/incontinence symptoms, greater bother and impact on quality of life compared to OAB subjects without anxiety (ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, OAB-q, p-values all <0.05). OAB subjects with anxiety also have more psychosocial difficulties (e.g., more depression, higher stress levels). Among OAB subjects, there were positive correlations between the severity of anxiety symptoms and the severity of OAB/incontinence symptoms (Spearman’s correlation coefficients 0.29 to 0.47, p<0.05). OAB subjects with both anxiety and depression reported higher ICIQ-UI and IIQ-7 scores than those who had anxiety but no depression (p=0.014, 0.025 respectively). Conclusions OAB patients reported higher anxiety symptoms compared to controls. OAB patients with anxiety reported more severe OAB/incontinence symptoms, worse quality of life, and more psychosocial difficulties compared to OAB patients without anxiety. There are positive correlations between the severity of anxiety symptoms and OAB/incontinence symptoms.

Purpose To compare the self-reported symptoms between IC/BPS and OAB based on patient-reported symptoms on validated questionnaires. Materials and Methods Patients diagnosed with IC/BPS (n=26) or OAB (n=53), and healthy controls (n=30), were prospectively recruited to participate in a questionnaire-based study that inquired their lower urinary tract symptoms using the following questionnaires: 1) Genitourinary pain index, 2) Interstitial cystitis symptom index and problem index, 3) International consultation on incontinence – overactive bladder, 4) International consultation on incontinence – urinary incontinence short form (ICIQ-UI), 5) Urgency severity scale, 6) numeric rating scales (NRS) of the severity of their bladder “pain, pressure, or discomfort”, and 7) NRS of severity of their urgency and 8) frequency symptoms. Results In univariate analyses, IC/BPS patients reported significantly more severe pain symptoms compared to OAB. OAB patients reported significantly more severe urinary incontinence symptoms compared to IC/BPS. There were no differences in the severity of frequency and urgency between IC/BPS and OAB. Surprisingly, 33% of OAB patients reported pain or discomfort when the bladder filled, while 46% of IC/BPS patients reported urgency incontinence. In multivariate analyses, the total scores on the ICIQ-UI Short Form (p=0.01) and the severity (NRS) of bladder pain (p<0.01) distinguished OAB from IC/BPS with a sensitivity of 90.6% and a specificity of 96.1% (OAB has higher ICIQ-UI and lower pain scores on NRS). Conclusions There is considerable overlap of self-reported symptoms between IC/BPS and OAB. This overlap raises the possibility that IC/BPS and OAB represent a continuum of a bladder hypersensitivity syndrome.