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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.

Figure. Associations between urological and nonurological measures and urgency urinary incontinence (UUI) severity as measured by Lower Urinary Tract Symptoms (LUTS) Tool. Forest plot of mixed effect linear regression model results for urological and nonurological factors at baseline. Regression coefficients are displayed on the right. *P < .05. GI indicates gastrointestinal; GUPI, Genito-Urinary Pain Index; POPDI-6, Pelvic Organ Prolapse Distress Inventory; PROMIS, Patient Reported Outcomes Measurement Information System; PSS, Perceived Stress Scale; QOL, quality of life; UDI-6, Urinary Distress Inventory.

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.