Overactive Bladder Patients With and Without Urgency Incontinence: A Spectrum of One Condition or Different Phenotypes?

Torosis, Michele; Jackson, Nicholas; Νitti, Victor W.; Ackerman, A. Lenore

doi:10.1097/spv.0000000000001254

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…A recent study of the Lower Urinary Tract Dysfunction Research Network (LURN) cohort revealed that OAB-dry individuals exhibit unique patterns of presenting features that differ from classic OAB subjects, including straining with urination, bladder discomfort, and a feeling of incomplete emptying. 12 The severity of symptomatic bother in these OAB-dry subjects was most closely related to the severity of pelvic floor tenderness on exam, implicating a possible myofascial dysfunction in this LUTS subgroup.…”

Section: Introductionmentioning

confidence: 79%

“…This analysis describes the features of that group of highly bothered patients who lacked the bladder pain or urgency incontinence characteristic of IC/BPS or OAB, but were symptomatic with urinary frequency, an uncomfortable urge to void without incontinence and bladder pressure, similar to the OAB-dry subset described within the LURN cohort. 12 In further characterizing this inadequately described phenotype of LUTS, we sought to confirm previously suggested associations with pelvic floor myofascial dysfunction, defining a novel subtype of storage LUTS we termed myofascial frequency syndrome (MFS).…”

Section: Introductionmentioning

confidence: 99%

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Myofascial Frequency Syndrome: A novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Ackerman

Jackson

Caron

et al. 2023

Preprint

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Background: Patients presenting with lower urinary tract symptoms (LUTS) are historically classified to several symptom clusters, primarily overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS). Accurate diagnosis, however, is challenging due to overlapping symptomatic features, and many patients do not readily fit into these categories. To enhance diagnostic accuracy, we previously described an algorithm differentiating OAB from IC/BPS. Herein, we sought to validate the utility of this algorithm for identifying and classifying a real-world population of individuals presenting with OAB and IC/BPS and characterize patient subgroups outside the traditional LUTS diagnostic paradigm. Methods: An Exploratory cohort of 551 consecutive female subjects with LUTS evaluated in 2017 were administered 5 validated genitourinary symptom questionnaires. Application of the LUTS diagnostic algorithm classified subjects into controls, IC/BPS, and OAB, with identification of a novel group of highly bothered subjects lacking pain or incontinence. Symptomatic features of this group were characterized by statistically significant differences from the OAB, IC/BPS and control groups on questionnaires, comprehensive review of discriminate pelvic exam, and thematic analysis of patient histories. In a Reassessment cohort of 215 subjects with known etiologies of their symptoms (OAB, IC/BPS, asymptomatic microscopic hematuria, or myofascial dysfunction confirmed with electromyography), significant associations with myofascial dysfunction were identified in a multivariable regression model. Pre-referral and specialist diagnoses for subjects with myofascial dysfunction were catalogued. Findings: Application of a diagnostic algorithm to an unselected group of 551subjects presenting for urologic care identified OAB and IC/BPS in 137 and 96 subjects, respectively. An additional 110 patients (20%) with bothersome urinary symptoms lacked either bladder pain or urgency characteristic of IC/BPS and OAB, respectively. In addition to urinary frequency, this population exhibited a distinctive symptom constellation suggestive of myofascial dysfunction characterized aspersistency: bothersome urinary frequency resulting from bladder discomfort/pelvic pressure conveying a sensation of bladder fullness and a desire to urinate. On examination, 97% of persistency patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. We therefore classified this symptom complexmyofascial frequency syndrome. To confirm this symptom pattern was attributable to the pelvic floor, we confirmed the presence ofpersistencyin 68 patients established to have pelvic floor myofascial dysfunction through comprehensive evaluation corroborated by symptom improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming that myofascial frequency syndrome is a distinct LUTS symptom complex. Interpretation: This study describes a novel, distinct phenotype of LUTS we classified as myofascial frequency syndrome in approximately one-third of individuals with urinary frequency. Common symptomatic features encompass elements in other urinary syndromes, such as bladder discomfort, urinary frequency and urge, pelvic pressure, and a sensation of incomplete emptying, causing significant diagnostic confusion for providers. Inadequate recognition of myofascial frequency syndrome may partially explain suboptimal overall treatment outcomes for women with LUTS. Recognition of the distinct symptom features of MFS (persistency) should prompt referral to pelvic floor physical therapy. To improve our understanding and management of this as-yet understudied condition, future studies will need to develop consensus diagnostic criteria and objective tools to assess pelvic floor muscle fitness, ultimately leading to corresponding diagnostic codes.

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Section: Introductionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Myofascial Frequency Syndrome: A novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Ackerman

Jackson

Caron

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…While the name suggests a similar spectrum as OAB, the absence of true urinary urgency is inconsistent with a diagnosis of OAB and suggests a different pathophysiology. A recent study of the Lower Urinary Tract Dysfunction Research Network (LURN) cohort revealed that such “OAB-dry” individuals exhibit unique patterns of presenting features that differ from classic OAB subjects, including straining with urination, bladder discomfort, and a feeling of incomplete emptying 15 . The severity of symptomatic bother in these OAB-dry subjects was most closely related to the severity of pelvic floor tenderness on exam, implicating a possible myofascial dysfunction in this LUTS subgroup.…”

Section: Introductionmentioning

confidence: 99%

“…In the application of our previously described, diagnostic nomogram to a real-world population of subjects with storage LUTS, we hypothesized that the nomogram would successfully identify and classifying subjects with OAB and IC/BPS, but also identify patient subgroups outside the classical LUTS diagnostic paradigm. This analysis describes the features of that group of highly bothered patients who lacked the bladder pain or true urgency characteristic of IC/BPS or OAB, but were symptomatic with urinary frequency, an uncomfortable urge to void without incontinence and bladder pressure, similar to the OAB-dry subset described within the LURN cohort 15 . In further characterizing this inadequately described phenotype of LUTS, we sought to confirm previously suggested associations with pelvic floor myofascial dysfunction, defining a novel subtype of storage LUTS we termed myofascial urinary frequency syndrome (MUFS).…”

Section: Introductionmentioning

confidence: 99%

Myofascial urinary frequency syndrome is a novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Ackerman,

Jackson,

Caron

et al. 2023

Sci Rep

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This study describes a novel, distinct phenotype of urinary symptoms named “myofascial urinary frequency syndrome” (MUFS) present in one-third of individuals presenting with urinary frequency. In addition to a characteristic symptom constellation suggestive of myofascial dysfunction, MUFS subjects exhibit “persistency”: a persistent feeling of needing to urinate regardless of urine volume. On examination, 97% of MUFS patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. To confirm this symptom pattern was attributable to the pelvic floor musculature, we confirmed the presence of “persistency” in 68 patients with pelvic floor myofascial dysfunction established through comprehensive examination and electromyography and corroborated by improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming MUFS is a distinct LUTS symptom complex.

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Review of the Impact and Burden of Urinary Urgency on Adults with Overactive Bladder

Wagg,

Ackerman,

Lai

et al. 2024

International Journal of Clinical Practice

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Overactive bladder (OAB) is a prevalent condition that impairs the quality of life in both men and women, and for many, urgency is the most bothersome symptom. Urgency is thought to drive the presentation of the other symptoms (frequency, nocturia, urgency urinary incontinence [UUI]). However, urgency has been understudied in clinical trials, potentially owing to inherent difficulties in its assessment. The definition of urgency related to OAB has been refined over the years, but it may not be easily understood by patients and clinicians, affecting its use in practice. Variability among the tools to measure urgency further complicates the matter. For example, some measure the frequency of urgency episodes and consider reduction of episode frequency as improvement in urgency severity. Others rate the severity of each episode of urgency along a scale, with some including an accompanying incontinence episode as the most severe form. Reduction in UUI episodes is often a primary endpoint in clinical studies, with many studies requiring UUI—sometimes called OAB‐wet—as an inclusion criterion, yet approximately two‐thirds of those with OAB do not experience UUI. If patients with OAB without UUI (i.e., OAB‐dry) are included, they are often not analyzed separately. Thus, it remains unknown if there are differences in treatment outcomes between patients with and without UUI and whether these differences are driven by pathophysiological processes. This narrative review highlights what is known about the pathophysiology of urgency, how urgency affects individuals with OAB, urgency measurement and associated challenges, and assessment of urgency in clinical trials.

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Overactive Bladder Patients With and Without Urgency Incontinence: A Spectrum of One Condition or Different Phenotypes?

Cited by 3 publications

References 20 publications

Myofascial Frequency Syndrome: A novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Myofascial Frequency Syndrome: A novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Myofascial urinary frequency syndrome is a novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Review of the Impact and Burden of Urinary Urgency on Adults with Overactive Bladder

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