Lower urinary tract symptoms (LUTS) are common in the general population. LUTS increase in prevalence with older age and are associated with significant impairments to quality of life. Multiple validated scoring systems exist to describe and quantify LUTS, such as the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms (ICIQ-LUTS) and the Patient Perception of Bladder Condition (PPBC) Scale. The ICIQ-LUTS Questionnaire  takes approximately five minutes to complete and asks patients to report their LUTS across categories of “storage”, “voiding”, and “incontinence” symptoms. For each ICIQ-LUTS question item, patients are asked to report the frequency with which they experience a symptom (a “symptom” question), as well as the degree to which patients feel bothered by this symptom (a “bother” question). Greater scores on "symptom" and "bother" questions indicate greater severity. The PPBC Scale is a single-question, six-point scale which asks patients to rate their subjective global perception of urinary incontinence (UI). Despite the abundance of validated questionnaires, there is currently no consensus on how to stratify and correlate the ICIQ-LUTS with patients’ perception of mild, moderate, or severe symptoms.  

We sought to achieve two aims in this study: First was to stratify the individual elements of the sex-specific ICIQ-LUTS questionnaires against the Patient Perception of Bladder Condition (PPBC) Score, which represents a patient’s overall perception of their LUTS. Secondly, we wanted to identify which which symptoms, or clusters of symptoms, contributed most to a patient's global perception of LUTS.

We undertook a retrospective cohort study of adult patients referred to a Continence Clinic in our city. We reviewed weekly continence clinic attendance lists between August 2019 and June 2021. Patients attending initial assessments between those periods were consecutively enrolled as study participants. For each study participant, we recorded their numeric responses to both the ICIQ-LUTS Questionnaire and the PPBC. No identifying information about participants were recorded. 

We then reviewed data for completeness. Participants were included in the data analysis if both PPBC and ICIQ-LUTS results were available for that participant. Participants were excluded if either PPBC, or ICIQ-LUTS scores were absent for that participant.

Data for male and female participants were analyzed separately. For each gender, measures of central tendency and dispersion were calculated for participant age and PPBC response scores. In consultation with a statistician, cross-tabulation was done for PPBC and each individual ICIQ-LUTS question to assess independence. Chi-Squared Statistics and Spearman's rank correlation coefficient were calculated for each PPBC and ICIQ-LUTS score pairs.

We reviewed 418 patient charts in total. From this sample, 211 participant charts were included in the data analysis. The remaining participants were excluded from analysis due to the absence of either a PPBC Score (n=179), or ICIQ-LUTS Score (n=28). Data for male (n=50) and female (n=161) participants were analyzed separately. 

Female participants completed the standard 12-item ICIQ-LUTS Questionnaire. Male participants completed the 23-item ICIQ-LUTS-Long Form (ICIQ-LUTS-LF) Questionnaire.

Mean age was 69.82 (range: 33-95) for female participants, and 73.58 (range: 38-95) for male participants. Among female participants, the mean reported PPBC Score was 4.35 (SD: 1.246), while for males, the mean reported PPBC Score was 4.16 (SD: 1.149). For both male and female participants, the median reported PPBC score was 4, corresponding to a statement that the patient's bladder symptoms "cause (some) moderate problems". Frequency table of participants' PPBC Scores are illustrated in Figure 1.

In females, there were statistically significant correlations between PPBC scores and ICIQ-LUTS questions describing “storage” and “incontinence” symptoms, but not “voiding” symptoms. Statistically significant correlations were observed between PPBC scores and most "bother" questions describing storage, voiding, and incontinence symptoms. 

In males, statistically significant correlations were only observed between PPBC and three of the 23 ICIQ-LUTS-LF symptom questions, and none of the "bother" questions. Cross-tabulation results of PPBC and ICIQ-LUTS scores for female and male participants are summarized in Figure 2.

Our findings suggest that, among female patients experiencing UI, increasing frequencies of storage- and incontinence-related symptoms correlated with patients' global perception of greater severity of their UI. Frequency variations in voiding-related symptoms did not correlate significantly with patients' global perception of greater severity of UI. From this, we believe that, female patients bothered by frequent storage- and incontinence-related LUTS are likely to report a higher degree of global severity of their UI.

In male participants, however, we only observed statistically significant correlation between three of the 23 ICIQ-LUTS-LF questions. The lack of statistically significant correlations is likely attributable to the small sample size of male respondents (n=50).

In this study we identified that female patients are likely to find storage- and incontinence-related LUTS as the greatest contributors to their overall global perception of LUTS (as reported by the PPBC), and voiding-related symptoms as relatively unrelated to patients' overall global perception of LUTS.

We recognize the small sample size in our study as a limitation, which was insufficient to stratify ICIQ-LUTS scores with PPBC in both males and females. Our sample size was also not sufficiently large to observe any significant correlations between PPBC and ICIQ-LUTS-LF questionnaires in male participants.

Despite these limitations, this study serves as a foundation for future research to investigate relationships between each participant-reported degree of global LUTS severity - as identified by a PPBC score between 1-6 - and the corresponding objective frequency of “storage” and “incontinence” symptoms - as measured by a score (or range of scores) on the sex-specific ICIQ-LUTS questionnaires.