Grant to help lower-urinary tract sufferers

Kreder, Karl

Lower-urinary tract dysfunction is a pretty common condition, affecting millions of men and women in the United States. Yet despite its prevalence, specialists have struggled with prescribing treatment that fully satisfies their patients.

“That’s the shortcoming (with current practice),” says Karl Kreder, M.D., professor and head of urology with University of Iowa Health Care. “It doesn’t equate to patients’ quality of life and how they view this disease.”

Karl KrederKreder and colleagues at the UI are leading an effort to bridge the gap between lower-urinary tract dysfunction diagnosis, treatment, and patient outcomes. The UI team, along with Duke University and Northwestern University, is creating a detailed questionnaire to better match a physician’s take and prescription on treating lower-urinary tract dysfunction with patients’ reports on their condition. The $1.8 million, five-year grant from the National Institutes of Health also will go toward better understanding how people with lower-urinary tract dysfunction differ from one another, known as phenotyping, with the aim to better match treatment to a particular person.

“It gets into individualized medicine and to see how people respond to one type of therapy or another,” Kreder explains.

The idea behind the questionnaire is to chart a patient’s response to physician-prescribed treatment and evaluate whether they feel better. This is important, because lower-urinary tract dysfunction can manifest itself in myriad ways, including the urgency and frequency (or lack thereof) to urinate, bladder sensation, and leaking. Each symptom can have a different cause, creating a puzzle of sorts where one treatment does not fit all. This “pathophysiology,” as specialists put it, is critical to tease out to administer the correct treatment option for each patient, and where the patient is satisfied the condition has been corrected.

The UI, Duke, and Northwestern team is charged with creating the questionnaire and surveying some 600 male and female patients nationwide, as well as determining the appropriate tools to evaluate responses and to classify patients according to symptoms.

Bradley, CatherineCatherine BradleyThe questionnaire is more involved than one might assume. First, it will be more relevant for women, whereas initial surveys targeted mostly men with urinary-tract conditions related to prostate problems, says Catherine Bradley, M.D., UI associate professor of obstetrics and gynecology and epidemiology and a co-principal investigator on the grant who is leading the questionnaire’s creation.

The questionnaire also will aim to compare people whose lower-urinary tract dysfunction may be caused by outside influences, such as trauma, stress, or psychological problems, from others with the condition.

From that phenotypic catalog, the researchers hope to be able to establish biomarkers, or what is happening in the body to trigger certain symptoms of the disease. If they can do that, then they can test which treatment is best suited for a given symptom.

“We’re going to be able to account for symptoms—how severe they are, how much they bother people, and what impact on quality of life they have,” Bradley notes. “Do they impact what people want to do in their everyday lives, impact sexual function, or impact patients’ moods, by causing frustration or embarrassment.”