A novel screening method is efficient for identifying myofascial urinary frequency syndrome (MUFS) in patients with lower urinary tract symptoms (LUTS), according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- The study introduces a novel screening method for identifying myofascial urinary frequency syndrome (MUFS) in patients with lower urinary tract symptoms (LUTS).
- There is a scarcity of diagnostic tools for evaluating LUTS, leading to a lack of consensus on a defined diagnostic schema. This often results in many patients with LUTS being lost to care.
- MUFS, a recently described LUTS, shares symptoms with other conditions such as overactive bladder, interstitial cystitis, and bladder pain syndrome. The new screening tool aims to accurately distinguish MUFS from these similar conditions.
- The screening tool involves 3 questionnaires—Female Genitourinary Pain Index, Overactive Bladder Questionnaire, and Pelvic Floor Distress Inventory 20.
- The tool demonstrated efficacy in diagnosing MUFS. Its early identification potential may lead to improved targeted therapy, recovery, and a reduction in unnecessary pharmacologic and procedural interventions for patients with LUTS.
Most individuals experience LUTS within their lifetime, but there are very few diagnostic tools available for evaluating them, and the ones currently available require significant clinical judgment. This leads to a lack of consensus on a defined diagnostic schema, causing many patients with LUTS to be lost to care.
MUFS is a recently described novel LUTS with symptoms including incomplete bladder emptying, urinary frequency, and a persistent desire to urinate. While common, MUFS is often mistaken as other conditions, including overactive bladder (OAB), interstitial cystitis (IC), and bladder pain syndrome (BPS), indicating a need for an accurate screening tool.
Investigators conducted a study to evaluate a screening tool in patients with potential MUFS. Participants received 3 questionnaires to complete: the Female Genitourinary Pain Index (fGUPI), Overactive Bladder Questionnaire (OAB-q), and Pelvic Floor Distress Inventory 20 (PFDI-20).
The nature and severity of genitourinary pain was measured by the fGUPI, continent and incontinent OAB symptoms by the OAB-q, and pelvic floor symptoms by the PFDI-20. There were 3 domains of pelvic health symptoms: urinary, defecatory, and prolapse.
The “Persistency Index (PI)” cohort contained patients with urinary symptoms with myofascial dysfunction as the source according to the attending physician. A standard pelvic floor examination was used to determine myofascial dysfunction.
Other groups included patients with OAB without bladder pain who endorsed substantial urgency incontinence (UI) and presented with detrusor overactivity, and patients diagnosed with IC or BPS with bladder pain but not incontinence. Asymptomatic patients were also included in the analysis as controls.
A validation cohort was also included to evaluate candidate symptomatic measure performance. The O’Leary-Sant Indices, including the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index, were given to this cohort to measure the severity and frequency of symptoms.
Patients with confirmed MUFS were compared with controls, as well as patients with OAB, IC, or BPS. Levels of urinary frequency and urge were similar between patients with MUFS and those with OAB, IC, or BPS, but without UI or bladder pain. Scores of incomplete emptying, dyspareunia, and defecatory dysfunction were increased in this group.
The PI was developed using candidate predictors from the administered validated questionnaires. Five of these had positive standardized shrunken coefficients greater than 0.4 and were used in a multivariable logistic regression model to predict MUFS, leading to a reduced model with an in-sample area under the curve (AUC) of 0.75.
MUFS was often reported in younger patients. When age was included in the model, the AUC rose to 0.8. The model contained a total possible score of 15. When identifying MUFS through scores of 7 or above, the model had an accuracy of 65%.
The model was also able to distinguish phenotypes, with a discordant nomogram classification to the physician-assigned diagnosis reported in only 18% of patients. The rate of inaccuracy was 15% for IC or BPS, 13% for MUFS, and 23% for OAB.
These results indicated efficacy from the model in diagnosing MUFS. Investigators concluded early identification may improve targeted therapy and recovery, as well as reducing rates of unnecessary pharmacologic and procedural interventions.
Reference
Ackerman AL, Torosis M, Jackson NJ, et al. The Persistency Index: a novel screening tool for identifying myofascial pelvic floor dysfunction in patients seeking care for lower urinary tract symptoms. Am J Obstet Gynecol. 2023;229:667.e1-11. doi:10.1016/j.ajog.2023.08.017
