George Fisch, Tel Aviv-Yafo, Israel, Alexander Fang*, Connelly Miller, Claire Choi, New York, NY, Thomas Monaghan, Dallas, TX, Edward Smith, Learta Prishtina, Jeffrey Weiss, Jerry Blaivas, New York, NY
Introduction: Patients with lower urinary tract symptoms (LUTS) may be subcategorized based on urinary output into polyuria, normal or oliguria groups as demonstrated by Blaivas et al (Can J Urol. 2021 Jun) and Clemens et al (Neurourol Urodyn., 2020 Apr). Polyuria may be caused by several pathologic conditions including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for the majority of patients, doing so in all may result in serious complications. This study investigates the prevalence of these pathologic conditions in LUTS patients with polyuria.
Methods: Two lower urinary tract databases were retrospectively queried to identify men and women presenting with LUTS who filled out the validated Lower Urinary Tract Symptom Score (LUTSS) questionnaire (Blaivas et al, Can J Urol 2015 Oct), a 24-hour bladder diary on a mobile app* or on paper, and met criteria for polyuria (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, CKD grade 3, and PPD. A one-way ANOVA was performed to compare groups and Pearson correlation was run examining the relationship between LUTSS and bother with 24 HVV, MVV and total voids.
*weShare® by Symptelligence Medical Informatics.com
Results: Among 814 total patients presenting with a chief complaint of LUTS, 146 (18%) men and women completed 24 HBD and LUTSS questionnaires and met criteria for polyuria. 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3 and 84.4% had PPD. Amongst groups, statistically significant differences were seen in measurements of 24 HVV, NUV, MVV, Daytime Voids, NPi, and Ni. A statistically significant relationship was seen between LUTSS and bother score, LUTSS and total voids, and bother and total voids.
Conclusions: 18% of the patients with LUTS in this series were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were phenotyped demonstrating significant differences in 24HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.
Source of Funding: Institute for Bladder and Prostate Research
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