CORRELATION BETWEEN SYMPTOM SEVERITY AND BOTHER IN WOMEN WITH LOWER URINARY TRACT SYMPTOMS
L. O'BOYLE1, Z. M. HIRSCH 2, L. J. POLICASTRO 3, J. G. BLAIVAS 4;
1Urology, Walter Reed Bethesda, BETHESDA, MD, 2Inst. for Bladder and Prostate Res., New York, NY, 3SUNY Downstate Med. Sch., Brooklyn, NY, 4Urology, SUNY Downstate Med. Sch., Brooklyn, NY.
Introduction: In clinical practice, minimal patient-subjective bother associated with lower urinary tract symptoms (LUTS) may lead to the treatment recommendation of reassurance and follow-up. The assumptions behind this management approach is that 1) if the symptoms are not bothersome, the underlying condition is not serious enough to warrant further investigation, and 2) the worse the symptoms, the greater a patient will be bothered by those symptoms. When assessing symptoms severity and bother, the addition of a validated grading tool is extremely valuable in both research and clinical practice. The Lower Urinary Tract Symptom Score (LUTSS) is an excellent instrument for clinical practice. The LUTSS is comprised of 14 questions, 9 addressing storage symptoms, 4 related to voiding and 1 for overall bother. Each questions is scored on a 5-point Likert scale graded zero to four.
Objective: The aim of this study is to evaluate these hypotheses: that bother is a direct indication of the severity of symptoms and/ or abnormality of one's LUTS, specifically voiding and storage according to Q and PVR data.
Methods: This is retrospective multicenter study of consecutive women referred for the evaluation of LUTS who completed the LUTSS as part of their evaluation. Contemporaneous uroflow (Q) and post-void residual (PVR) were gathered when available. When more than one Q or PVR was available, the best was used; voided volumes <150 mL were excluded. Spearman correlations were calculated for the bother sub-score against the total LUTSS, against each of the other sub-scores, and against Q and PVR.
Results: A total of 436 women, mean age 61 (range 15-95), that completed the LUTSS questionnaire as part of their initial evaluation were available for analysis. 38 women also had Q & PVR data available. Correlation between LUTSS score and degree of bother are shown in Table 1. The overall correlation between total LUTSS and bother was moderate (Figure 1). Correlation was considerably lower among those who rated their improvement “worse” than “about the same” (r = 0.30 vs 0.63). Among the specific symptom sub-scores (storage, OAB, voiding, incontinence, and nocturia) the correlation between the relevant sub-score and bother was fairly low (r = 0.33-0.54). No correlation was found between Q or PVR versus bother or total LUTSS.
Conclusions: The correlation between patient bother, symptom severity and the severity of the underlying condition is inexact. We found little to no correlation between Q, PVR and LUTSS scores. Some patients with little bother and few symptoms actually have abnormal Q and PVR data, while others were severely bothered by relatively minor symptoms. These findings highlight the importance and value of adding voiding and storage measures to the evaluation of LUTS and NOT to rely on subjective measures alone to guide management in clinical practice. The addition of a screening uroflow and PVR measurement in addition to a validated symptom instruments such as the LUTSS are highly valuable adjuncts to clinical practice.