Assessment of bladder pressure and discomfort symptoms: How do overactive bladder differ from interstitial cystitis/bladder pain syndrome patients?

BACKGROUND: To better understand the sensation of bladder pressure and discomfort , and how they are similar or distinct from the pain and urgency symptoms in IC/BPS and OAB. METHODS: IC/BPS and OAB patients rated their bladder pain, pressure, discomfort, and urinary urgency on separate 0-10 numeric rating scales (NRS). Their NRS ratings were compared between IC/BPS and OAB, and Pearson correlations were performed. RESULTS: Among IC/BPS patients (n = 27), their mean numeric ratings of pain, pressure, discomfort, and urinary urgency were almost identical (6.6 ± 2.1, 6.0 ± 2.5, 6.5 ± 2.2, and 6.0 ± 2.8 respectively). The three-way correlations between pain, pressure, or discomfort were very strong (all \u3e 0.77). Among OAB patients (n = 51), their mean numeric ratings of pain, pressure, and discomfort (2.0 ± 2.6, 3.4 ± 2.9, 3.4 ± 2.9) were significantly lower than urgency (6.1 ± 2.6, p \u3c 0.001). The correlations between urgency and pain, and between urgency and pressure were weak in OAB (0.21 and 0.26). The correlation between urgency and discomfort was moderate in OAB (0.45). The most bothersome symptom of IC/BPS was bladder/pubic pain, while the most bothersome symptom of OAB was urinary urgency and daytime frequency. CONCLUSIONS: IC/BPS patients interpreted bladder pain, pressure, or discomfort as the similar concepts and rated their intensity similarly. It is unclear whether pressure or discomfort provide additional information beyond pain in IC/BPS. Discomfort may also be confused with urgency in OAB. We should re-examine the descriptors pressure or discomfort in the IC/BPS case definition

Clustering of patients with overactive bladder syndrome

BACKGROUND: Overactive bladder is a heterogenous condition with poorly characterized clinical phenotypes. To discover potential patient subtypes in patients with overactive bladder (OAB), we used consensus clustering of their urinary symptoms and other non-urologic factors. METHODS: Clinical variables included in the k-means consensus clustering included OAB symptoms, urinary incontinence, anxiety, depression, psychological stress, somatic symptom burden, reported childhood traumatic exposure, and bladder pain. RESULTS: 48 OAB patients seeking care of their symptoms were included. k-means consensus clustering identified two clusters of OAB patients: a urinary cluster and a systemic cluster. The systemic cluster, which consisted of about half of the cohort (48%), was characterized by significantly higher psychosocial burden of anxiety (HADS-A, 9.5 vs. 3.7, p \u3c 0.001), depression (HADS-D, 6.9 vs. 3.6, p \u3c 0.001), psychological stress (PSS, 21.4 vs. 12.9, p \u3c 0.001), somatic symptom burden (PSPS-Q, 28.0 vs. 7.5, p \u3c 0.001), and reported exposure to traumatic stress as a child (CTES, 17.0 vs. 5.4, p \u3c 0.001), compared to the urinary cluster. The systemic cluster also reported more intense bladder pain (3.3 vs. 0.8, p = 0.002), more widespread distribution of pain (34.8% vs. 4.0%, p = 0.009). The systemic cluster had worse urinary incontinence (ICIQ-UI, 14.0 vs. 10.7, p = 0.028) and quality of life (SF-36, 43.7 vs. 74.6, p \u3c 0.001). The two clusters were indistinguishable by their urgency symptoms (ICIQ-OAB, OAB-q, IUSS, 0-10 ratings). The two OAB clusters were different from patients with IC/BPS (worse urgency incontinence and less pain). CONCLUSIONS: The OAB population is heterogeneous and symptom-based clustering has identified two clusters of OAB patients (a systemic cluster vs. a bladder cluster). Understanding the pathophysiology of OAB subtypes may facilitate treatments

Correlation between psychological stress levels and the severity of overactive bladder symptoms

BACKGROUND: The relationship between psychological stress and interstitial cystitis/bladder pain syndrome (IC/BPS) has been well described. Even though there is some overlapping of symptoms between overactive bladder (OAB) and IC/BPS, there have been very few studies that specifically investigated the relationship between psychological stress and urinary symptoms in OAB patients who do not have pelvic pain. Here we examined the relationship between psychological stress levels and the severity of overactive bladder (OAB) symptoms. METHODS: Patients diagnosed with OAB (n=51), IC/BPS (n=27), and age-matched healthy controls (n=30) participated in a case control study that inquired about their psychological stress levels using the perceived stress scale (PSS). PSS reported by the three patient groups were compared. Among OAB patients, their responses on the PSS was correlated to OAB symptoms using the following questionnaires: 1) international consultation on incontinence – urinary incontinence (ICIQ-UI), 2) international consultation on incontinence – overactive bladder (ICIQ-OAB), 3) OAB-q short form, 4) urogenital distress inventory (UDI-6), 5) incontinence impact questionnaire (IIQ-7), 6) urgency severity scale (USS), 7) numeric rating scales of urgency symptom, and 8) frequency symptom. Spearman’s correlation tests were performed to examine the relationship between psychological stress levels and the severity of OAB symptoms. RESULTS: OAB patients reported psychological stress levels that were as high as IC/BPS patients (median 17.0 versus 18.0, p=0.818, Wilcoxon sum rank test), and significantly higher than healthy controls (17.0, versus 7.5, p=0.001). Among OAB patients, there was a positive correlation between perceived stress levels and urinary incontinence symptoms (ICIQ-UI, Spearman’s correlation coefficient=0.39, p=0.007), and impacts on quality of life (UDI-6, IIQ-7, OAB-q quality of life subscale; Spearman’s correlation coefficient=0.32, 0.31, 0.39, and p=0.028, 0.005, 0.029, respectively). No significant correlation was observed between perceived stress levels and urgency or frequency symptoms (ICIQ-OAB, USS, numeric ratings of urgency and frequency). CONCLUSIONS: OAB patients reported psychological stress levels that were as high as IC/BPS patients, and significantly higher than healthy controls. There was a positive correlation between perceived stress levels and urinary incontinence symptoms, and its impacts on quality of life among OAB patients

DETERMINING THE EFFECTIVESNESS OF INCLUDING SPATIAL INFORMATION INTO A NEMATODE/NUTSEDGE PEST COMPLEX MODEL

An experiment was performed in 2005-2006 to determine if a nematode-resistant variety of alfalfa (Medicago sativa L.) can effectively reduce the pest complex consisting of yellow and purple nutsedge (YNS, Cyperus esculentus L. and PNS, C. rotundus L.) and the southern rootknot nematode (SRKN, Meloidogyne incognita (Kofoid & White) Chitwood). The alfalfa field, which had a history of severe infestation from both species of nutsedge and SRKN, was divided into 1m x 2m quadrats. In May, July and September of each year, eighty quadrats were randomly selected and counts of PNS, YNS and a soil sample (analyzed for the count of juvenile SRKN) were taken from each quadrat. Poisson regression models were fitted to see if information about YNS and PNS counts could be used to predict juvenile SRKN counts. In this study, two different ways to incorporate spatial information of quadrat locations within the field were examined to try to reduce over-dispersion in the original regression models. Spatial coordinates were first treated as fixed effects and then second, in separate models, as random effects using various spatial variance-covariance structures. Models with spatial coordinates as both fixed and random effects failed to converge, possibly because of small (n=80) sample size. The results of spatial models were compared to the original Poisson models, but there was not an effective way of comparing random-effects models with fixed-effects models. For this data, the use of spatial information did not improve the original model consistently. This may be partly because of the nature of the experiment. As hoped, the alfalfa crop effectively reduced YNS, PNS, and SRKN counts. The spatial information was generally more useful earlier in the experiment when the YNS, PNS, and SRKN populations were denser