To describe how specific common gender single item questions in the American Urological Association Symptom Index (AUASI) and the International Consultation on Incontinence Questionnaire Female or Male Lower Urinary Tract Symptoms (ICIQ-FLUTS / ICIQ-MLUTS) differ in reporting based on gender and age, in a patient population seeking care for lower urinary tract dysfunction.

Subjects were prospectively enrolled into an observational lower urinary tract symptom (LUTS) cohort from a functional urology clinic. Study participants underwent clinical evaluation and completed questionnaires pertaining to their lower urinary tract dysfunction, including the AUASI and in concordance with the patient’s gender, they completed the gender specific ICIQ-FLUTS or ICIQ-MLUTS questionnaires. Urological tests were performed, including pelvic and rectal examinations, post-void residual (PVR) urine measurement and urinalysis. Urine samples were collected, aliquotted and frozen for biobanking and future testing. Data were entered into a secure database and given a unique anonymous identifier to enable tracing of the results of our instruments. Similar single item questions which were not gender specific from the ICIQ-FLUTS and ICIQ-MLUTS were combined for statistical purposes. Logistic regression was performed to look at the association between LUTS, gender and age. Data were analyzed in SAS.

A total of 304 patients (178 female, 126 male) were enrolled. Mean age was 58±17 years. 540 clinic visits occurred between May 2019 and November 2020. Response rates were 93% (500/540) for AUASI, and 91% (490/540) for ICIQ. A logistic regression model by gender, adjusted for age (Figure 1), demonstrated a greater number of women with urgency using both instruments (AUASI OR 2.27, 95% CI 1.55-3.33; ICIQ OR 2.25, 95% CI 1.42-3.56). Women reported more voiding symptoms than men, including straining (AUASI OR 1.70, 95% CI 1.10-2.62; ICIQ OR 1.79, 95% CI 1.04-3.06). Incontinence was only represented by the ICIQ, where women reported more incontinence than men (ICIQ stress urinary incontinence (UI) OR 6.14, 95% CI 2.55-14.77; ICIQ unaware UI OR 2.18, 95% CI 1.03-4.62; ICIQ sleep UI OR 1.99, 95% CI 1.02-3.90; ICIQ urge UI OR 1.94, 95% CI 1.16-3.26). After adjusting for gender (Figure 2), nocturia was more likely to occur in older patients captured by the ICIQ (ICIQ nocturia OR 1.13, 95% CI 1.01-1.26). Urgency and urge UI occurred more in older subjects in the ICIQ domain for urgency (ICIQ urgency OR 1.16, 95% CI 1.02-1.32; ICIQ urge UI OR 1.23, 95% CI 1.06-1.43). Younger subjects were more likely to report hesitancy (ICIQ OR 0.74, 95% CI 0.65-0.84) and straining (AUASI OR 0.75, 95% CI 0.67-0.84; ICIQ OR 0.82, 95% CI 0.71-0.94).

The primary purpose of our study was to compare LUTS questionnaires between males and females, and identify how single items not specific for gender differ by age. To our knowledge no previously published studies of LUTS have compared single items between the AUASI and ICIQ questionnaires stratified by gender and age deciles. Our cohort study had successfully recruited a large number of men and women seeking treatment for LUTS in a short time frame. 

Our analysis found that that reporting on the AUASI and the ICIQ FLUTS and MLUTS questionnaires differ based on gender and age in a patient population seeking care for LUTS. The ICIQ FLUTS and MLUTS were found to be more sensitive than the AUASI at classifying storage and voiding dysfunction in men and women seeking care for LUTS. Female patients had a higher likelihood of reporting storage and incontinence symptoms than males in the ICIQ domain for incontinence. An older age increased the likelihood of having storage dysfunction, urgency and urgency urinary incontinence. Younger patients reported more voiding phase dysfunction in both the AUASI and the ICIQ. 

Our study has several strengths and limitations. As the individuals in this cohort represent a cross section of the English speaking patients who were able to complete the questionnaires in a tertiary care urology clinic, our findings may not be representative of the multi-lingual population of patients seeking care for LUTS. Strengths of our approach include our statistical methodology and the rigor with which questionnaires were recorded into our database, and the similar sampling of both genders which was accomplished in this single institution mixed-gender cohort with detailed medical and surgical history, and duplicative questionnaires capturing many of the patients’ urinary symptoms.

The AUASI and the ICIQ FLUTS / MLUTS differ based on sex and age in a patient population seeking care for LUTS. The ICIQ questionnaires capture symptom specific bother and incontinence. Further research is needed to better classify gender and age specific impact on LUTS reporting not captured by the AUASI.