TY - JOUR
T1 - Symptom Based Clustering of Men in the LURN Observational Cohort Study
AU - Liu, Gang
AU - Andreev, Victor P.
AU - Helmuth, Margaret E.
AU - Yang, Claire C.
AU - Lai, H. Henry
AU - Smith, Abigail R.
AU - Wiseman, Jonathan B.
AU - Merion, Robert M.
AU - Erickson, Bradley A.
AU - Cella, David
AU - Griffith, James W.
AU - Gore, John L.
AU - Delancey, John O.L.
AU - Kirkali, Ziya
N1 - Funding Information:
Accepted for publication May 15, 2019. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) through cooperative agreements (Grants DK097780, DK097772, DK097779, DK099932, DK100011, DK100017, DK097776 and DK099879), in part by NIH (National Institutes of Health) NCATS (National Center for Advancing Translational Sciences) Grant UL1TR001422 (Northwestern University). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This is publication No. 14 of the LURN. Supplementary material is posted at https://nih-lurn.org/publications.aspx.
Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Purpose:Conventional classification of patients with lower urinary tract symptoms into diagnostic categories based on a predefined symptom complex or predominant symptom appears inadequate. This is due to the frequent presentation of patients with multiple urinary symptoms which could not be perfectly categorized into traditional diagnostic groups. We used a novel clustering method to identify subtypes of male patients with lower urinary tract symptoms based on detailed multisymptom information.Materials and Methods:We analyzed baseline data on 503 care seeking men in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) Observational Cohort Study. Symptoms and symptom severity were assessed using the LUTS (Lower Urinary Tract Symptoms) Tool and the AUA SI (American Urological Association Symptom Index), which include a total of 52 questions. We used a resampling based consensus clustering algorithm to identify patient subtypes with distinct symptom signatures.Results:Four distinct symptom clusters were identified. The 166 patients in cluster M1 had predominant symptoms of frequency, nocturia, hesitancy, straining, weak stream, intermittency and incomplete bladder emptying suggestive of bladder outlet obstruction. The 93 patients in cluster M2 mainly endorsed post-micturition symptoms (eg post-void dribbling and post-void leakage) with some weak stream. The 114 patients in cluster M3 reported mostly urinary frequency without incontinence. The 130 patients in cluster M4 reported severe frequency, urgency and urgency incontinence. Most other urinary symptoms statistically differed between cluster pairs. Patient reported outcomes of bowel symptoms, mental health, sleep dysfunction, erectile function and urological pain significantly differed across the clusters.Conclusions:We identified 4 data derived clusters among men seeking care for lower urinary tract symptoms. The clusters differed from traditional diagnostic categories. Further subtype refinement will be done to incorporate clinical data and nonurinary patient reported outcomes.
AB - Purpose:Conventional classification of patients with lower urinary tract symptoms into diagnostic categories based on a predefined symptom complex or predominant symptom appears inadequate. This is due to the frequent presentation of patients with multiple urinary symptoms which could not be perfectly categorized into traditional diagnostic groups. We used a novel clustering method to identify subtypes of male patients with lower urinary tract symptoms based on detailed multisymptom information.Materials and Methods:We analyzed baseline data on 503 care seeking men in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) Observational Cohort Study. Symptoms and symptom severity were assessed using the LUTS (Lower Urinary Tract Symptoms) Tool and the AUA SI (American Urological Association Symptom Index), which include a total of 52 questions. We used a resampling based consensus clustering algorithm to identify patient subtypes with distinct symptom signatures.Results:Four distinct symptom clusters were identified. The 166 patients in cluster M1 had predominant symptoms of frequency, nocturia, hesitancy, straining, weak stream, intermittency and incomplete bladder emptying suggestive of bladder outlet obstruction. The 93 patients in cluster M2 mainly endorsed post-micturition symptoms (eg post-void dribbling and post-void leakage) with some weak stream. The 114 patients in cluster M3 reported mostly urinary frequency without incontinence. The 130 patients in cluster M4 reported severe frequency, urgency and urgency incontinence. Most other urinary symptoms statistically differed between cluster pairs. Patient reported outcomes of bowel symptoms, mental health, sleep dysfunction, erectile function and urological pain significantly differed across the clusters.Conclusions:We identified 4 data derived clusters among men seeking care for lower urinary tract symptoms. The clusters differed from traditional diagnostic categories. Further subtype refinement will be done to incorporate clinical data and nonurinary patient reported outcomes.
KW - cluster analysis
KW - diagnosis
KW - lower urinary tract symptoms
KW - patient reported outcome measures
KW - urinary bladder
UR - http://www.scopus.com/inward/record.url?scp=85074675890&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000000354
DO - 10.1097/JU.0000000000000354
M3 - Article
C2 - 31120372
AN - SCOPUS:85074675890
VL - 202
SP - 1230
EP - 1239
JO - The Journal of Urology
JF - The Journal of Urology
SN - 0022-5347
IS - 6
ER -