Core Lower Urinary Tract Symptom Score (CLSS) questionnaire: A reliable tool in the overall assessment of lower urinary tract symptoms

Objectives: To identify the symptoms of higher relevance in patients complaining of lower urinary tract symptoms (LUTS). Methods: A questionnaire covering 25 LUTS as defined by the International Continence Society (ICS) terminology committee was administered to 1000 adults complaining of LUTS and 360 not complaining (controls). Symptoms were defined as ‘highly relevant (core LUTS)’ when indicated by at least 25% of symptomatic patients with nine common diseases/conditions as one of the three symptoms that had a significant impact on their daily life. Results: Ten symptoms (daytime frequency, nocturia, urgency, urgency incontinence, stress incontinence, slow urinary stream, straining, feeling of incomplete emptying, bladder pain, and urethral pain) were selected as being of high relevance. Core LUTS all showed significantly higher scores in the symptomatic patients than in the controls and they were not correlated with other more prevalent symptoms. The Core LUTS score (CLSS) questionnaire derived from these 10 symptoms was confirmed as showing test‐retest reliability. Conclusions: Of 25 LUTS defined by the ICS committee, 10 symptoms were selected as core LUTS. The CLSS, a questionnaire for core LUTS, provides an overall assessment of relevant symptoms without significant omissions. It might be useful for new patients, those with multiple diseases, and those without a definite diagnosis, as well as before and after interventions that may cause other symptoms.     

尿动力学检查在女性下尿路疾病中的应用（附78例报告）

目的：研究以下尿路症状为主诉的女性患者的尿动力学变化及其临床意义。方法：女性患者,年龄21～86岁,临床表现为储尿期和（或）排尿期症状,采用尿动力学方法检查尿流率,同步膀胱压力容积流率及肛门括约肌肌电图测定。结果：以排尿症状为主者64例,以储尿症状为主者12例,不稳定膀胱2例。下尿路梗阻28例,其中功能性逼尿肌外括约肌协同失调的16例;子宫阴道下垂伴下尿路梗阻21例;压力性尿失禁18例,其中Ⅰ型5例,Ⅱ型3例,Ⅲ型3例,Ⅱ／Ⅲ型7例。正常9例。结论：尿动力学检查能了解膀胱的功能状况,为临床治疗的选择提供了可靠的依据。     

Epidemiologic Survey of Lower Urinary Tract Symptoms in Asia and Australia Using the International Prostate Symptom Score

Background The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia.
Methods The symptom index (0 to 35) and quality-of-life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia.
Results The percentages of Asian men considered to be symptomatic (symptom index ≧ 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively.
Conclusions Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.     

尿动力学检查在下尿路症状患者诊断中的价值（附324例报告）

目的：评价尿动力学在下尿路症状（LUTS）患者病因诊断中的重要价值。方法：对324例不同年龄的LUTS患者行尿流率、压力容积、压力-流率、前列腺压和肌电图检查,根据检查结果,行相应的临床治疗措施,比较治疗前后IPSS、QOL的变化。结果：根据尿动力学结果提示LUTS病因有5种,膀胱出口梗阻55．9％、逼尿肌受损、逼尿肌-括约肌失协调、不稳定膀胱、膀胱容量减少。制定相应治疗方案,取得良好临床效果。结论：尿动力学检查揭示LUTS的深层次病因,在LUTS患者的诊断、鉴别诊断及治疗方式的选择上具有重要的意义,值得临床推广应用。     

Validation of a patient-administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire

OBJECTIVE: To develop and validate a self-administered questionnaire to assess the 'severity' and 'bothersomeness' of the most frequently reported signs and symptoms of uncomplicated urinary tract infection (uUTI). SUBJECTS AND METHODS: The UTI Symptoms Assessment questionnaire (UTISA) is a 14-item instrument asking about the severity and bothersomeness of seven key uUTI symptoms. It was developed after comprehensive literature and data review and administration in draft form to a sample of 30 women with uUTI. The final questionnaire was completed by 276 women with uUTI who participated in a noncomparative clinical trial of ciprofloxacin. The women completed the questionnaire in electronic format at baseline (before the first dose of ciprofloxacin once-daily), at 3-h and 8-h intervals until all UTI symptoms were resolved, and at the test-of-cure visit. Baseline scores on the King's Health Questionnaire (KHQ) were used to assess convergent and divergent validity; responses to the Global Rating of Change (GRC) were used to assess both responsiveness and the 'minimally important difference'. Discriminant validity and responsiveness were assessed by comparing UTISA scores with a clinical evaluation of UTI symptoms performed by the investigator at baseline and at the test-of-cure visit. RESULTS: The UTISA was found to comprise three four-item domains named 'urination regularity', 'problems with urination', and 'pain associated with UTI'. Two questions asking about haematuria loaded on a fourth factor. The three domains were homogeneous (with high inter-item correlations) and internally consistent. Convergent validity was shown by high correlations between similar UTISA and KHQ domains (all r(s) > 0.40), and divergent validity by small correlations between unlike domains (all r(s) < 0.15). In general, the UTISA domains showed excellent discriminant validity, with scores on selected domains discriminating between women with different clinical evaluations. The responsiveness of the UTISA was also excellent, with high correlations between changes in domain scores and the clinical evaluation and GRC items. Symptom improvement was highest in the first 3 h, leading to greater responsiveness and minimally important difference during this period. However, the UTISA could detect even small subsequent changes. CONCLUSION: The three-domain UTISA has excellent psychometric properties and it is likely to prove an excellent tool for assessing uUTI outcome from a patient's perspective, both in research and clinical settings.     

下尿路症状合并勃起功能障碍联合用药的有效性和安全性

目的:评价多沙唑嗪、非那雄胺和西地那非联合治疗BPH相关的LUTS和ED的有效性和安全性。方法:采用双盲、随机、安慰剂对照的临床研究,84例患者随机分入A、B、C组,A组服用多沙唑嗪、非那雄胺和安慰剂,B组服用多沙唑嗪、安慰剂和西地那非,C组服用多沙唑嗪、非那雄胺和西地那非。16周后比较各组的IIEF-5、IPSS、Qmax、夜尿次数和残余尿等,并记录不良反应。结果:A、B、C组的IIEF-5分别提高10.2%、57.1%和57.6%,IPSS分别降低22.2%、20.8%和20.1%。18例(21.4%)患者有较轻的不良反应。结论:多沙唑嗪、非那雄胺和西地那非联合治疗BPH相关的LUTS和ED是安全有效的。     

A Longitudinal Population-based Survey of Urinary Incontinence,Overactive Bladder,and Other Lower Urinary Tract Symptoms in Women

Background

Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies.

Objective

To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression.

Design, setting, and participants

A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged ≥20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n = 2911), and available for reassessment in 2007 (n = 1408).

Methods

A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire.

Results and limitations

In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p < 0.001), and 3% (p < 0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p < 0.001).

Conclusions

UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.