THE CHARACTERIZATION OF OVERACTIVEBLADDER PHENOTYPES USING ELECTRONIC DATA CAPTURE
A. L. O'BOYLE1, Z. M.HIRSCH 2, L. POLICASTRO 3, J. G. BLAIVAS 4;
1Urology, Walter Reed Natl. Military Med. Ctr.,BETHESDA, MD, 2Inst. for Bladder and Prostate Res., NewYork, NY, 3SUNY Downstate Med. Sch., Brooklyn, NY,4Urology, SUNY Downstate Med. Sch., Brooklyn, NY.
Introduction: Overactive bladder(OAB) is a non-specific clinical diagnosis based on patient reportedsubjective lower urinary tract symptoms (LUTS). Although OAB has aunique ICD-10 designation, associated variables such as polyuria (P),Oliguria (O), small capacity bladder (S-MVV), large capacity bladder(L-MVV), and nocturnal polyuria (NP) may affect diagnosis andtreatment recommendations. The Lower Urinary Tract Symptom Score(LUTSS) is a validated tool developed to objectively characterizedand quantify lower urinary tract symptoms. The overactive bladdersub-score (OABSS) of the LUTSS has been validated to correspond to aclinical diagnosis of OAB. When combined with data obtained from a24-hour bladder diary (24HBD), uroflow (Q) and post-void residual(PVR) data, the LUTSS can identify important variations of the OABdiagnosis.
Objective: The purpose of this study was tofurther refine the OAB diagnosis by defining OAB variants or“phenotypes,” based on the combined LUTSS score, 24-hour bladderdiary (24HBD), uroflow (Q) and post-void residual (PVR) data with theultimate goal of establishing a foundation for developing optimaldiagnostic and treatment pathways in the future.
Methods:This is a retrospective multicenter observational study ofconsecutive women presenting for the evaluation of lower urinarytract symptoms (LUTS). Inclusion criteria were women who hadcompleted 24HBD and LUTSS questionnaires using a web base interfaceor smartphone application. Whenever available, the following data wasrecorded for each patient: maximum voided volume (MVV), 24 hourvoided volume (24HV), Q and PVR. Three major phenotypes wereidentified and empirically developed based on a theoretical treatmentalgorithm and 24HV: 1. Polyuria, 2. Normal, 3. Oliguria. Each majorphenotype was further categorized into subtypes according to themaximum voided volume (MVV): small capacity bladder, normal capacitybladder, and large capacity bladder. Each of these subtypes wassubdivided according to available Q and PVR: normal or abnormal. Wehypothesize that the major phenotypes along with the subtypes couldbe used to streamline, tailor or refine diagnostic and treatmentalgorithms.
Results: A total of 134 women, mean age of 59(range 18-94), with LUTS were evaluated with 24HBD and LUTSS data;107 met the LUTSS criteria for diagnosis of OAB. Of the women withOAB, 44 had Q & PVR data available (the full complement of Q &PVR data will be available at the time of presentation). Theproportion of women presenting according to the diagnostic phenotypesare shown in Figure 1. A total of 18 phenotypes wereidentified.
Conclusions: The stratification of OAB variantsinto phenotypes can help to optimize diagnostic and treatmentpathways as well as provide a proof of concept for the next researchphase based on each patient’s individualized characteristics. Wehave identified three major phenotypes based on 24HBD that arefurther subdivided according to MVV. Each sub-type can be evenfurther sub-divided according to Q and PVR data for a total 18 OABsubtypes. In the next phase of investigation we will focus on testingthese phenotypes in order to streamline treatment algorithms. Bycombining these data along with other parameters such as urgency andincontinence episodes we hope to tailor our electronic and clinicaldata gathering into a user friendly, efficient and cost-effectivemeans of caring for women with OAB. By combining both subjective andobjective data gathering into a central electronic repository we willbe able to more proactively identify women that will benefit fromtreatments such as behavior modification, medications, or third-lineOAB therapies. It is not our intent that practitioners commit these18 phenotypes to memory (this will be done by computer software), butsimply to raise awareness that they exist.