JU INSIGHT: Phenotyping of Urinary Urgency Patients Without Urgency Incontinence, and Their Comparison to Urgency Incontinence Patients: Findings From the LURN Study
By: H. Henry Lai, MD*; Jonathan B. Wiseman, MS; Margaret E. Helmuth, MA; Abigail R. Smith, PhD; Cindy L. Amundsen, MD; Anne P. Cameron, MD; Alexander P. Glaser, MD; Whitney K. Hendrickson, MD; Ziya Kirkali, MD; Kimberly Kenton, MD, MS | Posted on: 17 Jan 2023
*For the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)
Lai HH, Wiseman JB, Helmuth ME, et al. Phenotyping of urinary urgency patients without urgency incontinence, and their comparison to urgency incontinence patients: findings from the LURN study. J Urol. 2023;209(1):233-242.
Study Need and Importance
Despite its high prevalence, overactive bladder (OAB) patients with urinary urgency (UU) without urgency urinary incontinence (UUI)—the so-called OAB-dry patients—are poorly characterized. The pathophysiology of OAB-dry is poorly understood. Some hypothesize that UU is a milder manifestation of UUI, while others suggest UU may be a sensory or afferent disorder without detrusor overactivity, implying that UU and UUI may be 2 distinct entities with different underlying mechanisms. A third possibility is that UU represents an intermediate condition along a continuum of UUI and interstitial cystitis/bladder pain syndrome. To begin to answer this question, we characterized patients enrolled in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) study with UU with vs without UUI who presented to urology/urogynecology clinics seeking treatment for their symptoms.
What We Found
Among participants with UU at baseline, two-thirds also had UUI (OAB-wet), and one-third had UU only (OAB-dry). Patients with UUI have more severe storage symptoms, more severe bowel symptoms, more psychosocial symptoms, poorer physical functioning, and worse quality of life than those with UU only (see Figure). No differences were detected in urological pain between UU only and UUI. Our data suggested UUI may be a more severe manifestation of UU, rather than UU and UUI being distinct entities.
Limitations of this study were enrollment at large academic centers, which may reduce generalizability of the results to patients seeking care at primary care or general urology sites, and that the cohort was predominantly White (>80%), which reflected our population in clinics.
Interpretation for Patient Care
Data from the LURN study suggest that UUI may be a more severe manifestation of UU, rather than UU and UUI being distinct entities. This study emphasizes the need for additional studies examining whether OAB-wet and OAB-dry are truly 2 distinct phenotypes within OAB, or rather if they represent a continuum of symptom severity.