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Review
. 2016 Nov;196(5):1342-1349.
doi: 10.1016/j.juro.2016.05.117. Epub 2016 Jun 21.

Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms

Tamara G Bavendam #  1 , Jenna M Norton #  1 , Ziya Kirkali  1 , Chris Mullins  1 , John W Kusek  1 , Robert A Star  1 , Griffin P Rodgers  2
Affiliations
Review

Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms

Tamara G Bavendam et al. J Urol. 2016 Nov.

Abstract

Purpose: Lower urinary tract symptoms are common in the United States population, leading to significant economic, quality of life and public health issues. The burden will increase as the population ages, and risk factors for lower urinary tract symptoms, including diabetes and obesity, remain highly prevalent. Improving clinical management and establishing the knowledge base to prevent lower urinary tract symptoms will require a comprehensive research approach that examines factors beyond the lower urinary tract. While the study of extra-lower urinary tract factors has increased recently, current urological research does not systematically account for the broad set of potential contributing factors spanning biological, behavioral, psychological/executive function and sociocultural factors. A comprehensive assessment of potential contributors to risk, treatment response and progression is necessary to reduce the burden of this condition in the United States.

Materials and methods: We considered challenges to continuing the predominantly lower urinary tract dysfunction centric approach that has dominated previous research of lower urinary tract symptoms.

Results: We developed a new, comprehensive framework for urology research that includes a broader set of potential factors contributing to lower urinary tract symptoms. This framework aims to broaden research to consider a comprehensive set of potential contributing factors and to engage a broad range of researchers in the investigation of as many extra-lower urinary tract factors as possible, with the goal of improving clinical care and prevention.

Conclusions: We propose a new framework for future urology research, which should help to reduce the medical and economic burden of lower urinary tract symptoms in the United States population.

Keywords: behavioral medicine; executive function; lower urinary tract symptoms; psychology; social determinants of health.

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Figures

Figure 1
Figure 1. A Multi-level Framework for Considering Potential Causes and Contributors to LUTS
This schematic shows a comprehensive view of potential contributors to LUTS from the well-studied lower urinary tract at the center, to those increasingly less studied in each successive ring emanating from the center. Prior studies that have considered factors outside of LUT dysfunction have mostly focused on biologic domains, including local and systemic biology. There has been limited research on behavioral factors, such as diet, level of physical activity, and decisions about when to use the toilet. Even less well-studied are factors relating to psychology and executive functioning—including personality traits, self-efficacy, resiliency, and problem-solving ability—and social determinants of health (e.g., socioeconomic status, access to healthcare, availability of healthy food, environment). The NIDDK has promoted a shift in emphasis so that the major research studies of LUTS it supports—MAPP, LURN, and PLUS—now include a more comprehensive assessment of factors. The factors included in these “rings” often interact with each other. Factors across all rings of the schematic are influenced by age of the person and the time or duration of exposure, and several (e.g., LUT and local biology, systemic biology, behavior, and psychological and executive functioning) may be influenced by genetics.
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Comment in

  • Editorial Comment.
    Nickel JC. Nickel JC. J Urol. 2016 Nov;196(5):1348-1349. doi: 10.1016/j.juro.2016.05.130. Epub 2016 Aug 3. J Urol. 2016. PMID: 27496756 No abstract available.

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