LUTS PREVENTION IN ADOLESCENT GIRLS AND WOMEN ACROSS THE LIFESPAN

 描述(申请人提供)：下尿路症状(LUT)与女性的几种症状和诊断有关，包括尿失禁、膀胱过度活动、排尿功能障碍、尿路感染和间质性膀胱炎/膀胱痛综合征。这些症状/诊断是常见的，代价高昂，并导致生活质量显著下降。然而，尽管它们经常发生，但许多此类LUT是可以通过行为或内科/外科治疗来预防和治疗的。已经确定了LUTS的几个风险因素(例如，怀孕和分娩、晚年超重/肥胖)，并开发了几种行为疗法来预防高危妇女的这些LUTS(例如，孕妇的盆底肌肉训练)，并逆转或减少LUTS(例如，体重减轻)，从而提供了初级和二级LUTS预防的前景。然而，在我们能够实现LUTS预防之前，我们必须解决几个关键的知识差距。这些措施包括确定早发性LUT的风险因素，以便提供预防机会 在生活的早期；确认其他未被充分研究的风险因素以扩大预防的机会；综合现有文献以突出研究差距并帮助确定未来研究的优先顺序；建立健康的膀胱行为和正常的排尿功能作为未来干预的基础；以及更好地了解患者、提供者和结构性障碍(例如不干净的洗手间)以增加预防策略的覆盖范围和有效性。为了解决这些研究差距，我们利用我们多学科团队的不同专业知识，汇集了一系列创新、协作和多地点研究(在设计或潜力方面)。我们的共同目标是解决广泛的风险因素、LUT的全范围、四种感兴趣的生活方式中的每一种，以及 这一FOA的每一个目标。具体地说，我们建议：1)确定LUTS的风险因素 (超重/肥胖，习惯性业余高强度体力活动，习惯摄入含咖啡因、碳酸和人工加糖饮料，以及创伤事件和虐待)在大型、独特的《今日成长》研究1和2中；2)从定性和定量两个方面综合现有关于LUTS危险因素的流行病学文献，然后利用这些信息突出剩余的研究差距，并确定最重要的人群和危险因素以作为预防的目标；3)建立正常排尿行为和功能的证据基础，记录排尿环境，检查急性的、可改变的(排尿功能、排尿行为)和结构性因素(排尿环境)对排尿特征/急性下尿路梗阻的影响；4)通过患者和提供者的焦点小组和调查，确定患者、提供者和结构性障碍对整个生命周期预防LUTS的影响。共同努力，我们的目标将建立必要的证据基础，以启动未来对青少年和妇女的初级和二级LUTS预防的干预研究，这是跨预防LUTS联盟的最终目标。

 DESCRIPTION (provided by applicant): Lower urinary tract symptoms (LUTS) are associated with several syndromes and diagnoses in women, including urinary incontinence, overactive bladder, voiding dysfunction, urinary tract infections, and interstitial cystitis/bladder pain syndrome. These syndromes/diagnoses are common, costly, and lead to significant decreases in quality of life. Despite their common occurrence, however, many of these LUTS are readily preventable and treatable through behavioral or medical/surgical therapy. Several risk factors have been identified for LUTS (e.g., pregnancy and childbirth, later-life overweight/obesity) and several behavioral therapies have been developed to prevent these LUTS in high-risk women (e.g., pelvic floor muscle training in pregnant women) and to reverse or reduce LUTS (e.g., weight loss), offering the promise of both primary and secondary LUTS prevention. However, before we can achieve LUTS prevention, we must address several critical knowledge gaps. These include identification of risk factors for early-onset LUTS to allow prevention opportunities earlier in life; confirmation of additional under-studied risk factors to expand opportunities for prevention; synthesis of the existing literature to highlight research gaps and to help prioritize future research efforts; establishment of healthy bladder behaviors and normal voiding function as a basis for future interven- tions; and a better understanding of patient, provider, and structural barriers (e.g., unclean restrooms) to LUTS prevention to increase the reach and effectiveness of prevention strategies. To address each of these research gaps, we have assembled a portfolio of innovative, collaborative, and multi-site studies (in design or potential) drawing upon the diverse expertise of our multidisciplinary team. Together, our aims address a wide range of risk factors, the full spectrum of LUTS, each of the four lifestages of interest, and each of the objectives for this FOA. Specifically, we propose to: 1) identify risk factors for LUTS (overweight/obesity, habitual amateur high impact physical activity, habitual intake of caffeinated, carbonated, and artificially-sweetened beverages, and traumatic events and abuse) in adolescent girls and young, reproductive age women in the large, unique Growing Up Today Studies 1 and 2; 2) synthesize the existing epidemiologic literature on LUTS risk factors, both qualitatively and quantitatively, and then use this information to highlight remaining research gaps, and identify the most important populations and risk factors to target for prevention; 3) establish the evidence base for normal voiding behaviors and function, document the voiding environment, and examine the influence of acute, modifiable (bowel function, voiding behaviors) and structural factors (voiding environment) on voiding characteristics/acute LUTS; and 4) identify patient, provider, and structural barriers to LUTS prevention across the lifespan through focus groups of patients and providers, and through surveys. Together, our aims will establish the necessary evidence base to initiate future interventional studies of primary and secondary LUTS prevention in adolescents and women, which is the ultimate goal of the Trans-Prevention of LUTS Consortium.