The Comprehensive Assessment of Self-Reported Urinary Symptoms: A New Tool for Research on Subtypes of Patients with Lower Urinary Tract Symptoms

Abstract

Purpose: To improve the potential for finding clinically important subtypes of patients with lower urinary tract symptoms (LUTS), we describe the development of the Comprehensive Assessment of Self-reported Urinary Symptoms (CASUS) —and use it to present data on the experiences of LUTS in treatment-seeking women and men from a prospective observational cohort. Materials and Methods: An initial list of LUTS as confirmed in 22 qualitative interviews with providers and 88 qualitative interviews with care-seeking and non-care-seeking women and men with LUTS. Items from extant measures were adopted and revised and new items were developed, and all were evaluated for understanding in 64 cognitive interviews. Items were administered to a prospective cohort of female and male LUTS patients seeking care and analyses were conducted to describe item response distributions and correlations among item responses separately for women and men. Results: A total of 444 males and 372 females provided responses to CASUS. There were several sets of items that had different relationships for women compared to men. In particular, the associations between sensation-related items and incontinence-related items were generally positive among females, but were often negative among males. Conclusions: Using an intensive development process, the CASUS addresses a wide range of LUTS. It should help to identify clinically important subtypes of patients. Further, the collection of items can provide the foundation for shorter measures for use in the clinic and as trial endpoints.

A new outcome measure for LUTS: Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index‐29 (LURN SI‐29) questionnaire

“…It was developed from a longer, comprehensive set of urinary symptom items developed by the LURN for use in phenotyping research. 7 Five brief scales measuring urgency, incontinence, voiding difficulty, nocturia, and pain are supplemented with nine individual questions measuring voiding, nighttime urgency, constant urgency, incomplete emptying, leakage just after voiding, splitting, spraying, or change of direction of urine stream, and overall bother, together producing a total score. Internal consistency coefficients of the scales were consistently above the acceptable threshold of 0.70, and the scales were correlated with other commonly used LUTS questionnaires.…”

“…In summary, the LURN SI‐29 is a new 29‐item patient‐reported outcome tool. It was developed from a longer, comprehensive set of urinary symptom items developed by the LURN for use in phenotyping research . Five brief scales measuring urgency, incontinence, voiding difficulty, nocturia, and pain are supplemented with nine individual questions measuring voiding, nighttime urgency, constant urgency, incomplete emptying, leakage just after voiding, splitting, spraying, or change of direction of urine stream, and overall bother, together producing a total score.…”

“…All associations were positive, that is, higher (more severe) scores on the LURN SI-29 scales were associated with higher (more severe) scores on the validated scales. When the distribution of the LURN SI-29 scales was considered by AUA-SI severity category (mild [1][2][3][4][5][6][7], moderate [8][9][10][11][12][13][14][15][16][17][18][19], and severe [20-35]), all scales showed an increasing trend by severity category (Figure 2), with the exception of incontinence in men, which is not measured by AUA-SI.…”

“…To address this gap, LURN investigators developed a Comprehensive Assessment of Self‐Reported Urinary Symptoms (CASUS), which assesses a comprehensive set of 93 manifestations of LUTS. The goal of the current research was to reduce this comprehensive set of questions to a representative set of items for use as a clinical or research outcome questionnaire that captures aspects of LUTS relevant to both sexes .…”

“…To address this gap, LURN investigators developed a Comprehensive Assessment of Self‐Reported Urinary Symptoms (CASUS), which assesses a comprehensive set of 93 manifestations of LUTS. The goal of the current research was to reduce this comprehensive set of questions to a representative set of items for use as a clinical or research outcome questionnaire that captures aspects of LUTS relevant to both sexes . To develop this clinically relevant questionnaire, we used factor analyses as well as input from our large group of expert clinicians to ensure that the outcome questionnaire was psychometrically strong and included content appropriate for patients.…”