LURN II: Enhanced Characterization of Patients with LUTS Using Biopsychosocial Approaches

下尿路功能障碍症状研究网络(Lurn)于2012年成立，以 通过识别下尿路症状的重要亚型，增加我们对下尿路症状(LUT)的了解 LUTS患者，并改进LUTS患者体验测量。网络的方法 定义患者亚型的方法是基于重新抽样的共识聚类方法，该方法使用自 报告的患者数据，导致识别新的基于LUTS的集群，这些集群在统计上和 临床上是不同的。改善LUTS患者报告测量的方法是 根据患者、社区的质量输入，系统地开发新的、高质量的题库 参与者、内科医生、泌尿科医生、泌尿外科医生和临床研究人员。最后，为了理解 下尿路功能障碍的一些病理生理基础，生物学信息是 从患者样本和成像中获得并分析。在最初成功的5年筹资周期之后， Lurn准备在已获得的知识的基础上采取下一步行动，具体目标如下： 1)使用包括更广泛症状严重程度的队列来测试和改进原始的集群模型 和更大范围的生理测量，2)识别包含在 血浆，可用于识别患有LUT的男性和女性的特定亚群，以确定 女性下尿路症状(LUTS)表型特征的功能测定 下尿路成分，4)验证一种适用于患有以下尿路疾病的男性和女性的综合结果工具 以及5)确定心理社会压力--特别是不良童年经历--在 LUTS的严重程度和病程。Lurn II将招募1380名患者，按性别分层。我们的网站将招聘1/6 在这些参与者中(N=230)。我们有一种多种方法对LUTS患者进行表型鉴定， 将包括问卷调查、实验室测试、移动应用程序以及膀胱和尿路的尿动力学。数据 将使用基于重新采样的集群分析以及症状的纵向建模进行分析 时间到了。我们假设，我们评估LUTS患者的生物心理社会方法将在临床上产生- 有意义的患者集群，这反过来又可以与因果机制以及治疗选择联系在一起。 此外，我们假设，随着时间的推移，可修改的风险因素将与LUTS的进程相关，从而创造 治疗的新途径。这项研究的影响将有助于加深对 LUTS的原因和性质，这将为临床试验改善这些人的生活质量奠定基础 病人。

The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) was assembled in 2012 to increase our understanding of lower urinary tract symptoms (LUTS) by identifying important subtypes of patients with LUTS, and improving the measurement of patient experiences of LUTS. The Network's approach to defining patient subtypes was based on a re-sampling-based consensus clustering approach using self- reported patient data, resulting in the identification of novel LUTS-based clusters that are statistically and clinically distinct. The approach to improving the measurement of patient reports of LUTS was to systematically develop a new, high-quality item bank based on qualitative input from patient, community participants, internists, urologists, urogynecologists, and clinical researchers. Finally, in order to understand some of the pathophysiologic basis underlying lower urinary tract dysfunction, biologic information was obtained and analyzed from patient samples and imaging. After a successful initial 5-year funding cycle, LURN is prepared to build on the knowledge gained and take the next steps with the following Specific Aims: 1) To test and refine the original clustering model with a cohort including a wider range of symptom severity and a wider range of physiological measures, 2) To identify protein biomarker signatures contained within plasma that can be used to identify specific subgroups of men and women with LUTS 3) To determine phenotypic characteristics of women with lower urinary tract symptoms (LUTS) by measuring the functional components of the lower urinary tract, 4) To validate a comprehensive outcome tool for men and women with LUTS, and 5) To determine the role of psychosocial stress – especially adverse childhood experiences – in the severity and course of LUTS. The LURN II will recruit 1380 patients, stratified by sex. Our site will recruit 1/6 of these participants (N = 230). We have a multi-method approach to phenotyping patients with LUTS, which will include questionnaires, laboratory tests, mobile apps, and urodynamics of the bladder and urethra. Data will be analyzed using resampling-based cluster analyses, as well as longitudinal modelling of symptoms over time. We hypothesize that our biopsychosocial approach to assessing patients with LUTS will yield clinically- meaningful patient clusters, which in turn can be linked to causal mechanisms as well as treatment options. Moreover, we hypothesize that modifiable risk factors will be related to the course of LUTS over time, creating novel avenues for treatment. The impact of this study will lend itself to an improved understanding of the causes and nature of LUTS, which will set the stage for clinical trials to improve quality of life for these patients.