New Model Allows Early Stratification Of Patients With Overactive Bladder

A new model based on a combination of factors can accurately and noninvasively stratify patients with overactive bladder (OAB) into low-symptom and high-symptom groups early in the course of disease.

"To be able to determine urinary biomarkers of early disease was an unexpected and wonderful discovery, and we hope that we can use this new knowledge to diagnose and treat individuals before their symptoms develop to the point so as to be significantly impactful on everyday life," Dr. John S. Young of the University of Portsmouth, in the UK, told Reuters Health by email.

OAB is defined by the presence of bothersome symptoms of urinary urgency, increased frequency and nocturia in the absence of other obvious pathology, but there is an unmet need for an objective symptom-based classification of patients not only for participation in clinical trials, but also for day-to-day management.

Dr. Young and colleagues used cluster analysis to identify potential symptom-based groupings of 95 patients with OAB and assessed the individual and combinational abilities of OAB urinary biomarkers, plus participant age and gender, in predicting the identified groupings.

Cluster analysis identified two groups of patients, with urgency being the primary factor accounting for the differences between the groups. One group had significantly higher urgency, incontinence, frequency and nocturia. Patients in this group were significantly older than in the other group, which had few symptoms, the researchers report in Scientific Reports.

While the levels of individual urinary biomarkers did not differ significantly between the two groups, the combination of urinary levels of interleukin (IL)-5 and adenosine triphosphate (ATP) with age and gender accurately identified the probability of an individual being in the high-symptom group.

This model (and five other models) had higher negative predictive value and positive predictive value for diagnosing OAB for both females and males, compared with urodynamically observed detrusor overactivity.

"Having determined that combinations of chemicals in urine are predictive of OAB, we are working towards an in vitro diagnostic device to be used in clinical practice—by physicians and other healthcare practitioners at point of care (general practice, surgeries, pharmacies, and nursing/care homes)," Dr. Young said.

"The scientific literature treats OAB dichotomously: a patient has it or they do not. Such a view is more appropriate for a disease," he said. "But as a symptom complex with a broad range of symptom severities, I would hope that we can be more proactive in diagnosing and treating its symptoms at an earlier stage."

"As we and others have shown that significant remodeling of the bladder occurs with OAB progression, I suspect that current interventions are less efficacious the further OAB develops," Dr. Young said.

The study did not have commercial funding, but Dr. Young and one of his coauthors are inventors on patents filed by their institution based on the research.

—Will Boggs MD


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