LUTS PREVENTION IN ADOLESCENT GIRLS AND WOMEN ACROSS THE LIFESPAN

 描述（由申请人提供）：下尿路症状（LUTS）与女性的几种综合征和诊断相关，包括尿失禁、膀胱过度活动症、排尿功能障碍、尿路感染和间质性膀胱炎/膀胱疼痛综合征。这些综合征/诊断是常见的，昂贵的，并导致生活质量显着下降。尽管它们经常发生，但是，许多这些LUTS是容易预防和治疗的，通过行为或药物/手术治疗。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）和几种行为疗法已经被开发来预防高危妇女的这些LUTS（例如，孕妇的骨盆底肌肉训练）和逆转或减少LUTS（例如，体重减轻），提供了初级和二级LUTS预防的希望。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。这些措施包括识别早发性LUTS的风险因素，以提供预防机会 早年生活中，确认其他未充分研究的风险因素以扩大预防机会;综合现有文献以突出研究差距并帮助优先考虑未来的研究工作;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;以及更好地理解患者、提供者和结构障碍（例如，卫生间不干净）与LUTS预防相结合，以扩大预防战略的覆盖面和有效性。为了解决这些研究差距中的每一个，我们已经组装了一个创新，协作和多站点研究（在设计或潜力）的组合，利用我们的多学科团队的不同专业知识。总之，我们的目标是解决广泛的风险因素，LUTS的全谱，四个生命阶段的每一个， 本FOA的每一个目标。具体而言，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，习惯性摄入含咖啡因，碳酸和人工甜味饮料，以及创伤事件和虐待）在大型，独特的成长今天研究1和2中的青春期女孩和年轻育龄妇女中; 2）定性和定量地综合现有关于LUTS风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，并确定预防目标的最重要人群和风险因素; 3）建立正常排尿行为和功能的证据基础，记录排尿环境，并检查急性、可改变的（肠功能，排尿行为）和结构性因素（排尿环境）对排尿特征/急性下尿路症状的影响;以及4）通过患者和提供者的焦点小组以及通过调查，确定患者、提供者和在整个生命周期中预防下尿路症状的结构性障碍。总之，我们的目标将建立必要的证据基础，以启动青少年和妇女的初级和二级LUTS预防的未来干预性研究，这是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.