Abstract
BackgroundOveractive 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.MethodsClinical 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.Results48 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 < 0.001), depression (HADS-D, 6.9 vs. 3.6, p < 0.001), psychological stress (PSS, 21.4 vs. 12.9, p < 0.001), somatic symptom burden (PSPS-Q, 28.0 vs. 7.5, p < 0.001), and reported exposure to traumatic stress as a child (CTES, 17.0 vs. 5.4, p < 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 < 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).ConclusionsThe 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.
Highlights
Overactive bladder is a heterogenous condition with poorly characterized clinical phenotypes
Recent research suggested that non-urologic factors such as anxiety, depression, psychological stress, somatic symptom burden, non-urologic pain, and increased hypersensitivity related to central sensitization might contribute to the symptomatology of overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) [4,5,6,7,8,9,10]
48 OAB patients (13 men, 35 women) had complete data for consensus clustering. Their characteristics are presented in Table 1. k-means clustering identified two OAB clusters: a urinary cluster and systemic cluster
Summary
Overactive bladder is a heterogenous condition with poorly characterized clinical phenotypes. Recent research suggested that non-urologic factors such as anxiety, depression, psychological stress, somatic symptom burden, non-urologic pain, and increased hypersensitivity related to central sensitization might contribute to the symptomatology of OAB and other lower urinary tract symptoms (LUTS) [4,5,6,7,8,9,10]. This observation raises the possibility that the OAB population is heterogeneous and may be further sub-categorized based. We incorporated patients’ urinary symptoms and non-urologic factors into consensus clustering to identify potential patient subtypes within OAB
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