While some patients with lower urinary tract dysfunction (LUTD) have etiologies limited to peripheral or end- organ dysfunction (e.g. bladder, urethra, vagina, prostate and/or pelvic floor muscle dysfunction), we hypothesize that many patients have central or systemic pathophysiologic processes contributing to their symptoms. For example, women and men with a history of childhood or adult trauma and those with psychological co-morbidities may represent one group of patients who have a systemic process causing or contributing to their LUTD. To better understand and develop targeted treatment approaches for patients with such central LUTD, the Iowa Research Site proposes to perform multicenter and multidisciplinary research with other sites to 1) develop and test an innovative symptom-based instrument for men and women which will better characterize LUTD patients' urologic symptoms and symptom-related bother and 2) collect detailed and extensive longitudinal data (including symptom-based outcome measures and biomarkers) in men and women with LUTD to better understand phenotypic subgroups of patients. We will recruit equal numbers of men and women with clinically- and urodynamically-defined LUTD, including detrusor overactivity with or without urge incontinence, stress urinary incontinence and obstruction. Data collection will occur at baseline, monthly and at 12 months, including symptom progression and flares. Furthermore, we will obtain both systemic (salivary cortisol, serum C-reactive protein, and resting heart rate and blood pressure) and urinary (inflammatory cytokines, neurotropins, stress proteins, tissue remodeling proteins) biomarkers related to neuroendocrine dysfunction and systemic inflammation, which may correlate with systemic vs. peripheral LUTD phenotypes.
Results from this project will improve our ability to assess patients' lower urinary tract symptoms and symptom- related bother. We will then better identify subgroups of patients for whom targeted and more effective treatments can be developed.
