Prevention Of Lower Urinary Tract Symptoms Research Articles

Design of a Tool Capable of Assessing Environmental Sociocultural Physical Factors Influencing Women's Decisions on When and Where to Toilet Within Real-World Settings: Protocol for the Build and Usability Testing of a Mobile App for Use by Community-Dwelling Women.

Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women's decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when "thinking about my bladder" and shortly before "I just peed," (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. RR1-10.2196/54046.

Black women's perspectives on bladder health: Social-ecological and life course contexts.

This paper explores Black women's perspectives on bladder health using a social-ecological conceptual framework and life course perspective. We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member-checking session where all participants self-identified as Black or African American. Forty-two participants aged 11-14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically-rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress-related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems. Bladder health promotion interventions should address social-ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.

MP37-13 INTER-RATER AND INTRA-RATER RELIABILITY OF UROFLOWMETRY INTERPRETATION IN ADULT WOMEN

You have accessJournal of UrologyCME1 Apr 2023MP37-13 INTER-RATER AND INTRA-RATER RELIABILITY OF UROFLOWMETRY INTERPRETATION IN ADULT WOMEN Leslie M. Rickey, Elizabeth R. Mueller, Diane K. Newman, Alayne D. Markland, Chloe Falke, Kyle Rudser, and Emily S. Lukacz Leslie M. RickeyLeslie M. Rickey More articles by this author , Elizabeth R. MuellerElizabeth R. Mueller More articles by this author , Diane K. NewmanDiane K. Newman More articles by this author , Alayne D. MarklandAlayne D. Markland More articles by this author , Chloe FalkeChloe Falke More articles by this author , Kyle RudserKyle Rudser More articles by this author , and Emily S. LukaczEmily S. Lukacz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-invasive uroflowmetry is often used to assess lower urinary tract symptoms (LUTS). However, interpretation and characterization of flow patterns is not well established. Subjective interpretation is the most common approach for flow curve classification, and variable parameters have been reported for uroflowmetry curves. We sought to describe the reliability of uroflowmetry curve interpretation in adult women. METHODS: Uroflowmetry studies were obtained in 296 adult women who participated in an observational Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for inter-rater reliability and a random subset of 50 tracings were re-reviewed by each investigator for intra-rater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous with fluctuation, interrupted, and prolonged. Tracings could also be categorized as uninterpretable or ambivalent if the voided volume was <150ml or the reviewer could not assign one of the pattern categories. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters was summarized with kappa (k) statistics and percentage where at least 3 raters agreed. RESULTS: The mean age of participants was 44.8±18.3years. Participant age categories were: 18-24y 20%; 25-34y 18%; 35-64y 43%; ≥65y 19%. Nine percent described their race as Asian, 31% Black, 62% White and 95% non-Hispanic origin. The inter-rater reliability was highest for the continuous flow category (k=0.65), 0.41 for continuous with fluctuation, 0.47 for interrupted, and 0.41 for prolonged flow curves. Agreement amongst at least 3 raters occurred in 74.3% uroflow curves (45.9% for continuous, 13.5% for continuous with fluctuation, 3.4% for interrupted, and 4.1% for prolonged). For intra-rater reliability, the mean kappa across the four raters was 0.72 with a range of 0.57-0.85. CONCLUSIONS: Currently accepted uroflowmetry curve categories have fair to moderate inter-rater reliability and is lower for flow curves that don’t meet “continuous” criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use as a research parameter. Algorithms that can process numerical and pattern data may also improve the reliability of uroflowmetry studies as a diagnostic and predictive tool for LUTS interventions. Source of Funding: The content of this [abstract/ presentation/ poster] is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is supported by the National Institutes of Health (NIH) through cooperative agreements (grants U24DK106786, U01DK106853, U01DK106858, U01DK106898, U01DK106893, U01DK106827, U01DK106908, U01DK106892, U01DK126045). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e519 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leslie M. Rickey More articles by this author Elizabeth R. Mueller More articles by this author Diane K. Newman More articles by this author Alayne D. Markland More articles by this author Chloe Falke More articles by this author Kyle Rudser More articles by this author Emily S. Lukacz More articles by this author Expand All Advertisement PDF downloadLoading ...

MP03-11 THE BRAIN, GUT &amp; BLADDER HEALTH NEXUS UNDERLYING STRESS &amp; MENTAL HEALTH DISORDERS IN WOMEN

You have accessJournal of UrologyCME1 Apr 2023MP03-11 THE BRAIN, GUT & BLADDER HEALTH NEXUS UNDERLYING STRESS & MENTAL HEALTH DISORDERS IN WOMEN Ariana Smith, Amanda Berry, Linda Brubaker, Shayna Cunningham, Sheila Gahagan, Lisa Kane Low, Margaret Mueller, Siobhan Sutcliffe, Beverly Williams, and Brady Sonya Ariana SmithAriana Smith More articles by this author , Amanda BerryAmanda Berry More articles by this author , Linda BrubakerLinda Brubaker More articles by this author , Shayna CunninghamShayna Cunningham More articles by this author , Sheila GahaganSheila Gahagan More articles by this author , Lisa Kane LowLisa Kane Low More articles by this author , Margaret MuellerMargaret Mueller More articles by this author , Siobhan SutcliffeSiobhan Sutcliffe More articles by this author , Beverly WilliamsBeverly Williams More articles by this author , and Brady SonyaBrady Sonya More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The relationship between the brain, gut and bladder is complex. To aid further studies to understand the relationship between specific stressors and mental health disorders (MHD), intestinal sequelae and lower urinary tract symptoms (LUTS) we aim to identify potential mechanisms and biological processes that explain brain-gut-bladder associations in women. METHODS: Identification of mechanisms followed guidelines of conceptual model development. RESULTS: Traumatic events, chronic stressors and MHD may lead to a maladaptive stress response with implications for communication and signaling between the brain, gut and bladder. Figure 1 depicts three bidirectional axes; the gut, brain and bladder are key actors engaged in “communication” across the life course. Each organ function is guided by key inputs that ideally assist in maintaining health but also can initiate or exacerbate dysfunction. The gut can communicate with the brain and bladder in ways that shape trajectories of MHD, neuropsychological resilience, central physiological dysregulation and the likelihood of developing and experiencing persistent LUTS. Psychological stressors influence communication between the gut and the brain with accompanying alterations in gut metabolites, neurotransmitters and microbiota. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters (serotonin, dopamine), amino acids (tryptophan), short chain fatty acids (butyrate, acetate) and amyloid proteins that influence the brain (neuronal, blood, immune pathways), thus mediating communication between the gut and brain. Gut bacteria also alter inflammatory immune response via endotoxins, conferring vulnerability or resistance to bladder infections. Microbiota signal neurogenesis, microglia maturation and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission, synaptogenesis & the vagus nerve. CONCLUSIONS: Some neurotransmitter alterations seen with stress may not be caused directly by perceptions of stress, but rather by stress-related alteration in intestinal bacteria. The brain-gut-bladder axis has implications for research as well as novel prevention and treatment approaches. An intriguing area for research is how the microbiome may influence the brain & bladder. Source of Funding: The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is supported by the National Institutes of Health (NIH) through cooperative agreements (grants U24DK106786, U01DK106853, U01DK106858, U01DK106898, U01DK106893, U01DK106827, U01DK106908, U01DK106892, U01DK126045) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e26 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ariana Smith More articles by this author Amanda Berry More articles by this author Linda Brubaker More articles by this author Shayna Cunningham More articles by this author Sheila Gahagan More articles by this author Lisa Kane Low More articles by this author Margaret Mueller More articles by this author Siobhan Sutcliffe More articles by this author Beverly Williams More articles by this author Brady Sonya More articles by this author Expand All Advertisement PDF downloadLoading ...

Women's Knowledge of Bladder Health: What We Have Learned in the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium.

The goal of this manuscript is to review the current literature on bladder health education, summarize Prevention of Lower Urinary Tract Symptoms (PLUS) [50] findings on environmental factors that influence knowledge and beliefs about toileting and bladder function, and describe how PLUS work will contribute to improved understanding of women's bladder-related knowledge and inform prevention intervention strategies. Analysis of focus group transcripts revealed the various ways women view, experience, and describe bladder function. In the absence of formal bladder health educational platforms, women appear to develop knowledge of normal and abnormal bladder function from a variety of social processes including environmental cues and interpersonal sources. Importantly, focus group participants expressed frustration with the absence of structured bladder education to inform knowledge and practices. There is a lack of bladder health educational programming in the USA, and it is unknown to what degree women's knowledge, attitudes, and beliefs influence their risk of developing lower urinary tract symptoms (LUTS). The PLUS Consortium RISE FOR HEALTH study will estimate the prevalence of bladder health in adult women and assess risk and protective factors. A Knowledge, Attitudes, and Beliefs (KAB) questionnaire will be administered to determine KAB around bladder function, toileting, and bladder-related behaviors, and examine the relationship of KAB to bladder health and LUTS. The data generated from PLUS studies will identify opportunities for educational strategies to improve bladder health promotion and well-being across the life course.

17. Creating a Research Program to Promote Bladder Health in Adolescent Women

The majority of women over the course of their lifetime eventually experience lower urinary tract symptoms (LUTS), such as dysuria, urgency, or incontinence. It is currently unknown how to best promote bladder health in women across the life course. The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, funded by the National Institutes of Health, aims to identify factors that promote female bladder health from adolescence to older adulthood. PLUS recognizes the importance of adolescence as a critical period for prevention and the formation of lifelong bladder health behaviors. This research program description will introduce the PLUS Research Consortium and describe its adolescent-focused research components.

Is the juice worth the squeeze? Transdisciplinary team science in bladder health.

Prior research on lower urinary tract symptoms (LUTS) has focused on the treatment and management of these conditions with scant attention to prevention. The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was formed to address the complexities of preventing LUTS and promoting bladder health. Herein, we describe challenges faced and strategies used to develop the PLUS Research Consortium into an engaged and productive transdisciplinary scientific team. We apply four previously defined team science phases (development, conceptualization, implementation, and translation) to frame our progress. Strategies to progress through the development phase included the generation of a shared mission, and valuing of other disciplinary perspectives. The conceptualization phase included generating a shared language and developing a team transdisciplinary orientation. During the implementation phase, the group developed roles and procedures and focused on conflict management. The translation phase includes continued refinement of the mission and goals, implementation of research protocols, and robust dissemination of the scientific work products related to bladder health. A diverse group has matured into a productive transdisciplinary team science consortium. Achieving this outcome required dedicated effort for each member to engage in activities that often required more time than single discipline research activities. Provision of the necessary time and tools has fostered a transdisciplinary team science culture and rich research agenda that reflects the complexity of the health issue to be addressed. Our experience may be useful for others embarking on team science projects.

Development of Conceptual Models to Guide Public Health Research, Practice, and Policy: Synthesizing Traditional and Contemporary Paradigms.

This applied paper is intended to serve as a "how to" guide for public health researchers, practitioners, and policy makers who are interested in building conceptual models to convey their ideas to diverse audiences. Conceptual models can provide a visual representation of specific research questions. They also can show key components of programs, practices, and policies designed to promote health. Conceptual models may provide improved guidance for prevention and intervention efforts if they are based on frameworks that integrate social ecological and biological influences on health and incorporate health equity and social justice principles. To enhance understanding and utilization of this guide, we provide examples of conceptual models developed by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. PLUS is a transdisciplinary U.S. scientific network established by the National Institutes of Health in 2015 to promote bladder health and prevent lower urinary tract symptoms, an emerging public health and prevention priority. The PLUS Research Consortium is developing conceptual models to guide its prevention research agenda. Research findings may in turn influence future public health practices and policies. This guide can assist others in framing diverse public health and prevention science issues in innovative, potentially transformative ways.

Novel (Multilevel) Focus Group Training for a Transdisciplinary Research Consortium.

Health researchers are increasingly turning to qualitative research for a nuanced understanding of complex health phenomena. The quality and rigor of qualitative research relies on individual data collector skills, yet few guidelines exist for training multidisciplinary, multi-institution qualitative research teams. Specific guidance is needed on qualitative research practices that ensure scientific rigor by optimizing diverse experience and expertise across research centers. We describe our systematic approach to training a cohort of 15 focus group moderators from seven universities in the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium's Study of Habits, Attitudes, Realities, and Experiences (SHARE). SHARE's aim was to explore women and girls' experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. Drawing on adult education and action-learning best practices, a three-phase curriculum was designed to maximize moderator proficiency and qualitative research expertise. The phases involved online, interactive web-based education, in-person didactic training with experiential components, and tailored supplemental online training. Evaluative feedback was collected before, during, and after the training. Feedback was used to identify emergent training needs. This training approach may be used by transdisciplinary research teams conducting multisite research to assure qualitative research credibility and trustworthiness.

U.S. Adolescent and Adult Women's Experiences Accessing and Using Toilets in Schools, Workplaces, and Public Spaces: A Multi-Site Focus Group Study to Inform Future Research in Bladder Health.

The World Health Organization recognizes access to clean and safe toilets as crucial for public health. This study explored U.S. adolescent and adult cisgender women’s lived experiences accessing toilets in schools, workplaces, and public spaces. As part of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, we conducted 44 focus groups with female participants (n = 360; ages 11–93). Focus groups were stratified by age (11–14, 15–17, 18–25, 26–44, 45–64, 65+) and conducted across 7 geographically diverse U.S. sites from July 2017–April 2018. Using a transdisciplinary approach, we conducted conventional qualitative coding informed by our PLUS conceptual framework and used content analysis processes to identify salient themes. Across settings, toilet access was restricted by “gatekeepers” (i.e., individuals who control access to toilets). In contrast, self-restricting toilet use (deciding not to use the toilet despite biologic need to urinate) was based on internalized norms to prioritize school and job responsibilities over urination. In public spaces, self-restricting use was largely in response to lack of cleanliness. Across the life course, participants perceived gender disparities in the ability to easily access public toilets. Further research is needed to determine if and how these factors impact bladder health across the life course.

Prevention of Lower Urinary Tract Symptoms Research Consortium Focus Group Study of Habits, Attitudes, Realities, and Experiences of Bladder Health.

The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviors related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area. This focus group study will be implemented across seven geographically diverse United States research centers using a semi-structured focus group guide informed by a conceptual framework based on the socioecological model. The study was approved in July 2017. A total of 44 focus groups composed of 6-8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions and urinary symptom experience. Up to 10 of these focus groups will be conducted in Spanish. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes. This foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women. This study has the potential to provide new insights and understanding into adolescent and adult women's lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course. This article is protected by copyright. All rights reserved.

Terminology for bladder health research in women and girls: Prevention of Lower Urinary Tract Symptoms transdisciplinary consortium definitions.

To report research terminology and definitions for describing healthy bladder function among women and girls. The Prevention of Lower Urinary tract Symptoms (PLUS) Consortium developed research terminology and definitions for elements of healthy bladder function based on existing understanding of storage and emptying functions of the bladder and accepted definitions of lower urinary tract symptoms (LUTS). The novel concept of a bladder "bioregulatory" function was also proposed. Elements of bladder function corresponding to bladder health (BH) and LUTS were developed and refined using an iterative process. A comprehensive reference table structured by bladder function (Storage, Emptying, and Bioregulatory) and elements of each function was created to document proposed research terminology and definitions. The BH research definitions for each bladder function are: (1) Storage: the ability to hold urine for a reasonable duration of time and sense bladder fullness without fear of or concern about urgency, discomfort or leakage; (2) Emptying: the ability to empty the bladder completely in a timely, efficient, effortless, comfortable manner; and (3) Bioregulatory: the bladder barrier protects the individual/host from pathogens, chemicals, and malignancy. Research definitions for seven Storage, seven Emptying, and three Bioregulatory elements of function are presented. Novel LUTS research definitions were developed when gaps in existing definitions were identified or nonclinical language was desired. PLUS BH definitions reflect a transdisciplinary approach to standardizing research definitions for elements of bladder function from a perspective of health rather than dysfunction and provide a framework for studying BH in clinical practice, public health promotion, and LUTS prevention.

The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: Developing a conceptual framework for a prevention research agenda

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was established by the National Institutes of Health in 2015 to expand research beyond the detection and treatment of lower urinary tract symptoms (LUTS) to the promotion and preservation of bladder health and prevention of LUTS in girls and women. While many multi-disciplinary scientific networks focus on pelvic floor dysfunction and LUTS, the PLUS Consortium stands alone in its focus on prevention. This article describes the PLUS approach to developing a conceptual framework to guide the Consortium's initial prevention research agenda. The conceptual framework was informed by traditional social ecological models of public health, biopsychosocial models of health, Glass and McAtee's Society-Behavior-Biology Nexus, and the World Health Organization's conceptual framework for action on the social determinants of health. The PLUS conceptual framework provides a foundation for developing prevention interventions that have the greatest likelihood of promoting and preserving bladder health among diverse populations. PLUS Consortium work is premised on the notion that programs, practices, and policies designed to promote health will have optimal impact if the conceptual foundation upon which efforts are based is comprehensive and informed by multiple disciplines. The PLUS conceptual framework is broadly applicable to domains of health that have historically focused on the treatment of illness and symptoms rather than the promotion of health. It is also applicable to domains of health that have been examined from a predominantly biological or social ecological perspective, without integration of both perspectives.

A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion.

Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health. The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed. PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures. PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives.

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium: A Transdisciplinary Approach Toward Promoting Bladder Health and Preventing Lower Urinary Tract Symptoms in Women Across the Life Course.

Lower urinary tract symptoms (LUTS) are highly prevalent in women, and are expected to impose a growing burden to individuals and society as the population ages. The predominance of research related to LUTS has focused on underlying pathology, disease mechanisms, or the efficacy of treatments for women with LUTS. Although this research has been vital for helping to reduce or ameliorate LUTS conditions, it has done little to prevent the onset of LUTS. Health promotion and prevention require an expansion of scientific inquiry beyond the traditional paradigm of studying disease mechanisms and treatment to the creation of an evidence base to support recommendations for bladder health promotion and, in turn, prevention of LUTS. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) introduced the concept of prevention as an important priority for women's urologic research as a prelude to supporting the formation of the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium. In this article, we introduce the PLUS research consortium to the scientific community; share the innovative paradigms by which the consortium operates; and describe its unique research mission: to identify factors that promote bladder health across the life course and prevent the onset of LUTS in girls and women.

Association between the Self-Perception Period of Lower Urinary Tract Symptoms and the International Prostate Symptom Score

Objectives: The timing of visiting a hospital after self-perception of lower urinary tract symptoms (LUTS) is different between individuals. The association between the self-perception period (S-PP) of LUTS and the progression of LUTS has seldom been documented. The aim of this study was to investigate the association between the S-PP of LUTS and the International Prostate Symptom Score (IPSS). Subjects and Methods: This was a cross-sectional study comprising 267 men aged 40 years and older who participated in a prostate examination survey between February and May 2009. Survey questionnaires included items on the IPSS, the S-PPs of seven individual LUTSs assessed in the IPSS. Results: The S-PP of LUTS became significantly longer as the severity of LUTS increased. Of the seven symptoms, a weak urinary stream and nocturia showed longer S-PPs than others. Partial correlation between the S-PP and IPSS showed a statistically significant positive correlation. Linear regression analysis showed a statistically significant relationship that unstandardized coefficients included 0.051 and 0.005 for IPSS and quality of life. Conclusions: These findings suggest that the S-PP is an independent risk factor for LUTS progression. S-PPs have to be considered for treatment or prevention of LUTS.