Hypothesis / aims of study
Overactive bladder (OAB), a multifaceted symptom complex, is most common in women and comprised of urinary urgency, frequency, nocturia and urge incontinence . It is defined as a symptom complex due to its unknown etiology . In this novel study, we aim to evaluate the correlation between symptom questionnaires and bladder diaries with respect to urgency void incidents (UVI) in women. This study was completed using a mobile app* in which patients completed the Lower Urinary Tract Symptom Score (LUTSS) questionnaire and a 24-hour bladder diary (24HBD) that documented each micturition accompanied by UVI.
Study design, materials and methods
In this IRB approved study, an established database was searched to identify women ≥18 years of age who completed a 24-HBD and/or LUTSS questionnaire from 2015 through 2018. The LUTSS questionnaire is a validated 14 item symptom questionnaire consisting of a total and 6 sub scores – voiding dysfunction, storage symptoms, OAB, incontinence, nocturia and bother . The OAB sub score is comprised of seven questions relating to OAB - urgency, frequency, urge incontinence, and bladder control. The score ranges from 0 - 24, with 24 being maximum symptom severity.
Data from OAB sub score of the LUTSS and 24HBD were contemporaneously matched within a two-week period. Women with significant changes in symptoms or management during the two-week period and/or had incomplete data entry were excluded. The 24HBD documents the time and volume of each void and whether it was accompanied by a UVI. The total number of voiding incidents in 24 hours accompanied by UVI was correlated with the OAB sub score using Pearson’s correlation coefficient (r).
Interpretation of results
The weak correlation between reported symptom scores and bladder diaries shows a lack of alignment between the perception of symptom severity and results from an objective tool, such as a bladder diary. Possible explanations for this include: 1) differences in patients’ perception of symptoms, 2) variations of symptoms that are better illustrated by patients’ recollection over a period of time rather than a time-limited diary, or 3) patients’ difficulties in expressing personal experiences into a symptom score and bladder diary.
One weakness in this study is that only one 24HBD was utilized rather than the 3 day bladder diary used in most clinical studies. We accepted a lower test-retest reliability in return for a higher compliance rate and because of the well documented lower compliance with longer bladder diaries .