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Reasons for Seeking Clinical Care for Lower Urinary Tract Symptoms: A Mixed Methods Study

James W. Griffith, Emily E. Messersmith, Brenda W. Gillespie, Jonathan B. Wiseman, Kathryn E. Flynn, Ziya Kirkali, John W. Kusek, Tamara Bavendam, David Cella, Karl J. Kreder, Jasmine J. Nero, Maria E. Corona, Catherine S. Bradley, Kimberly S. Kenton, Brian T. Helfand†, Robert M. Merion, Kevin P. Weinfurt and the LURN Study Group
DOI: http://dx.doi.org/10.1016/j.juro.2017.07.067


Purpose
The primary objective of this study was to evaluate reasons for seeking care among men and women with lower urinary tract symptoms.

Materials and Methods
Participants were recruited from urology and urogynecology clinics, and the community. The sample was enriched with persons expected to have abnormal or diminished bladder sensations (eg participants with lower back surgery and participants 65 years old or older). Interviews were performed in person beginning with an open-ended assessment of urinary symptoms and associated bother followed by more directed questions, including reasons for seeking or not seeking treatment. We also examined the relationship between symptom frequency and bother using the LUTS (Lower Urinary Tract Symptoms) Tool.

Results
A total of 88 participants, including 38 men and 50 women, with a mean ± SD age of 52.2 ± 14.3 years provided information about urinary symptoms, including a range of quality of life consequences and coping behaviors. They sought treatment mostly because of new, continuing or bothersome symptoms. Factors associated with not seeking treatment included low symptom severity and concerns about the costs vs the benefits of treatment (eg side effects of medication). Symptom frequency and bother were associated with each other across symptoms assessed by the LUTS Tool.

Conclusions
In this large qualitative study we obtained useful insights into the impact of lower urinary tract symptoms from the perspective of the person with the symptoms. Removing barriers and misconceptions about the treatment of lower urinary tract symptoms may increase the number of people who seek clinical care and improve the clinical course of men and women who experience lower urinary tract symptoms.

Key Words:
urinary bladder, lower urinary tract symptoms, quality of life, patient reported outcome measures, patient acceptance of health care

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