Should we explain lower urinary tract symptoms to patients?

Digesu, G. Alessandro; Khullar, Vik; Panayi, Demetri; Calandrini, Marco; Gannon, Michael; Nicolini, Umberto

doi:10.1002/nau.20527

Cited by 21 publications

(20 citation statements)

References 10 publications

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“…Thus, an advantage of the LUTS Tool is its use of non‐medical terminology. Digesu et al22 explored the percentage of women who could correctly define LUTS symptoms and found that patient understanding of these terms was suboptimal for accurate diagnoses. By comparison, the LUTS Tool was developed using qualitative data from both men and women with LUTS, mimicking the phrases and terms used by LUTS patients to describe their symptom frequency and bother 14.…”

Section: Discussionmentioning

confidence: 99%

Moving towards a comprehensive assessment of lower urinary tract symptoms (LUTS)

Coyne¹,

Barsdorf

Thompson³

et al. 2012

Neurourology and Urodynamics

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Section: Discussionmentioning

confidence: 99%

Moving towards a comprehensive assessment of lower urinary tract symptoms (LUTS)

Coyne¹,

Barsdorf

Thompson³

et al. 2012

Neurourology and Urodynamics

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“…34 In a study of 2737 women with UI symptoms, 1626 (59%) reported mixed UI, of whom 42% had USI, 25% had pure DO, 18% had both DO and USI and 15% had normal UDS. 35 In those with stress-predominant MUI, 64% had pure USI and in those with urgency-predominant MUI, only 47% had solely DO.…”

Section: Urodynamicsmentioning

confidence: 94%

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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“…8 We clearly need a better insight into the sensation of urgency that we are talking about, and furthermore find a clear description understandable by patients at the 6th grade level. Before we can fine tune the definition, some issues should be addressed: should we demarcate sudden and gradual urgency, should we differentiate by perceived cause of urgency and can we use definitions to stratify patients by clinical condition?…”

Section: Abstract: Afferent; Sensation; Urgencymentioning

confidence: 99%

Urgency: All or none phenomenon?

Wachter

Hanno

2010

Neurourology and Urodynamics

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Urgency is the key symptom of a very prevalent symptom complex, the overactive bladder syndrome. Addressing urgency as a hallmark for detrusor overactivity is for physicians very comfortable, but appears to be an oversimplification of a very complex symptom entity. This overview tries to put the relevant literature on urgency against the question whether urgency is an all or none phenomenon, and summarizes the current views on how urgency is perceived.

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Should we explain lower urinary tract symptoms to patients?

Abstract: Our findings showed that most women do not know the correct meaning of LUTS terminology currently used by physicians.

Cited by 21 publications

References 10 publications

Moving towards a comprehensive assessment of lower urinary tract symptoms (LUTS)

Moving towards a comprehensive assessment of lower urinary tract symptoms (LUTS)

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Urgency: All or none phenomenon?

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