BERKELEY, CA (UroToday.com) - Questionnaires have become widespread in urology and serve as a useful way of gathering detailed information about subjective symptoms, including the effect of a condition or treatment on a patient's quality of life. The O'Leary Sant symptom and problem indexes, the University of Wisconsin Symptom Instrument, and the Pressure, Urgency, Frequency (PUF) questionnaires have been used for Painful Bladder Syndrome / Interstitial Cystitis as screening tools, diagnostic questionnaires, and to follow the course of disease. Only the Wisconsin and O'Leary Sant are validated tools, and validation is only for following the course of disease. All questionnaires tend to identify overactive bladder as well as PBS/IC, largely because of the common symptom of urgency and the melding together of urgency because of a need to prevent incontinence (OAB) and urgency because of pain (PBS/IC). Because OAB is 10-30 times more common than PBS/IC, confusion when questionnaires are used for diagnosis or screening is a major problem.

Stanley Althof and colleagues from the United States, Ireland, Canada, and the United Kingdom argue that there may come a time in the future when some disorders including sexual dysfunction, overactive bladder, lower urinary tract symptoms (LUTS), and painful bladder disease may primarily be diagnosed by validated questionnaires. They conclude, however, that it is unlikely that questionnaires can completely replace physiological tests, and both measures have their advantages and limitations. When to choose questionnaires or physiological tests and to reliably base our judgments on their findings still remains s largely unresolved in many therapeutic areas. Even in subjective conditions or well-established areas, the use of physiological tests can be useful in evaluating organic abnormalities and refractory cases.

This article provides a good jumping-off place for this discussion. In PBS/IC, I would expect the next step in the evolution of questionnaires to be their validation and use for epidemiologic studies. A logical next step would be for screening individual patients, but we are not their yet by a long shot.

BJU Int. 2005 Dec; 96(9):1210-2