Bother, symptom severity often poorly correlated in LUTS

The correlation between patient-reported bother and symptom severity is inexact, according to conclusions of a recent retrospective multicenter study of nearly 1,200 patients referred for lower urinary tract symptoms (LUTS).

Some patients with severe bother had few symptoms, while others with little bother had moderate symptoms, investigators said at the International Continence Society annual meeting in Florence, Italy.

In particular, a poor correlation between bother, urine flow rate (Q), and post-void residual (PVR) suggests that serious underlying conditions such as urethral obstruction might be misdiagnosed if clinicians rely too much on bother in their diagnostic evaluations, according to Jerry G. Blaivas, MD, of Weill Cornell Medical College, New York.

“Although there is a reasonable correlation between some symptoms and bother, the correlation isn't sufficient for you to hang your hat on,” Dr. Blaivas said in an interview with Urology Times. “Therefore, we believe that the patients that complain of urinary symptoms should undergo a basic evaluation and that bother itself should not be the driving force.”

Bother plays a significant role in initial patient evaluation in many treatment algorithms for lower urinary tract symptoms. For example, the AUA guideline on management of BPH states that no further evaluation is recommended if such symptoms are not significantly bothersome. The authors base the recommendation on expert opinion that the emergence of significant health problems related to this condition are not likely in patients with non-bothersome LUTS.

To evaluate the hypothesis that bother should drive the diagnostic evaluation in patients with LUTS, Dr. Blaivas and colleagues conducted retrospective multicenter investigations of 1,189 individuals referred for LUTS who had completed a lower urinary tract symptom score (LUTSS) questionnaire on a mobile app or website (weShare, Symptelligence Medical Informatics). At the time, both Q and PVR had also been evaluated in these patients.

Of the 436 females in the study, there was a strong correlation between bother score and total LUTS score (0.65), investigators reported. However, there was only a moderate correlation (0.42) between bother and total AUA Symptom Score (AUASS).

Next: "Considerable overlap" between symptom severity and bother

They also found a moderate correlation between bother scores and storage and overactive bladder (OAB) sub-scores (0.54, 0.53 respectively), and a moderate correlation between bother and voiding sub-score (0.40), but noted “considerable overlap” between symptom severity and bother; some patients with severe symptoms had little bother, while others with few symptoms had more serious bother.

In particular, 25% of patients with no bother had Q <11 mL, and 8% had PVR >200 mL, investigators said, describing this finding as “disconcerting” in that they represent a subset of patients with LUTS in whom serious conditions could be overlooked if bother score is driving the diagnosis.

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There was only a weak correlation between bother scores and incontinence and nocturia subscores (0.35 and 0.33, respectively), but most importantly, according to the authors, there was no correlation found between bother scores and either Q or PVR.

Results in the male subset (n=753) were similar, according to data presented in a separate abstract at the ICS meeting.

“If a patient has symptoms and they say, ‘it doesn't bother me,’ then to the extent possible, I think our response should be, ‘well, even though it doesn't bother you, let's just make sure there isn't something serious underlying your symptoms’,” Dr. Blaivas said.

Dr. Blaivas and colleagues reported funding from the Institute for Bladder and Prostate Research. Dr. Blaivas is chief scientific officer & co-founder of Symptelligence Medical Informatics.

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