Pathways to LUTS Prevention: A Model for Public Education, Behavioral Skills, and Early Detection

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 DESCRIPTION (provided by applicant): Lower urinary tract symptoms (LUTS) encompass a wide range of symptoms including urinary incontinence, urinary frequency, urgency, nocturia, bladder pain syndrome, and symptoms of voiding dysfunction. There is an extensive literature describing the many approaches to treatment of LUTS, but much less is known about prevention. Epidemiological studies have identified numerous risk factors for LUTS, but evidence is lacking for the roles of behavioral factors, including how we learn our bladder habits, whether they affect the risk of developing LUTS, and what defines healthy bladder habits. The primary aim of this proposal is to participate as a Clinical Center in the "Prevention of Lower Urinary Tract Symptoms in Women: Bladder Health Clinical Centers" (PLUS) Research Consortium and work with other centers to examine the existing evidence and plan foundational studies for development of future trials of prevention interventions for LUTS. The University of Alabama at Birmingham (UAB) Continence Team is an interdisciplinary group of investigators from behavioral science, geriatrics, preventive medicine, public health, urogynecology, and urology. Our epidemiological work includes identifying risk factors for incident incontinence using the NIA-funded UAB longitudinal Study of Aging, national VA databases, and risk factor analyses of NHANES data. The depth of the UAB team covers all aspects of LUTS clinical trial design and conduct (including NIH multi-site networks), evaluation and treatment of LUTS in women, and a strong track record of recruitment and retention of both patients and control subjects (including being a Vanguard Center for the NHLBI Women's Health Initiative). The second aim is to address known gaps in current epidemiological knowledge, through a prospective longitudinal cohort study to assess a range of behavioral factors and their effect on the incidence and progression of LUTS. Understanding the roles of bladder health behaviors will support the development of a risk model for identifying individuals and groups at risk for LUTS, as well as inform public education initiatives. The third aim is to conduct foundational studies guided by our conceptual framework to develop three potential pathways to prevention of LUTS: public education initiatives targeted across the lifespan to convey knowledge and dispel myths about healthy bladder habits and LUTS; skill-based interventions for young women and at-risk groups to teach evidence-based behavioral skills and healthy bladder habits; and detection of and self-administered interventions for early LUTS. The plan of studies includes 1) the longitudinal cohort study, which will also provide meaningful content for public education campaigns, 2) a survey of providers to assess feasibility of teaching pelvic floor muscle control and healthy bladder habits to young women at a time of relative readiness - the first gynecology encounter, and 3) developing and pilot testing an internet-based, self-administered behavioral intervention including a smart-phone application as a practical first step in addressing early LUTS. Findings from these studies will lay the foundation for future trials of interventions to prevent LUTS in women across the lifespan.