Nonbiologic factors that impact management in women with urinary incontinence: review of the literature and findings from a National Institute of Diabetes and Digestive and Kidney Diseases workshop: Beyond the Abstract

The urology research community has made tremendous efforts over the past several decades leading to major advances in the management of men and women with urinary incontinence (UI) and other lower urinary tract symptoms (LUTS). But much remains to be accomplished. Existing treatments are not consistently successful, even in patients with very similar clinical presentation. It is therefore difficult if not impossible for clinicians to know which treatment will be optimal for any given patient. We have yet to explore many potential contributors to LUTS and many modulators of treatment. 

To address these challenges, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is calling for a shift in perspective on urology research.1 Where once urology research was primarily unidisciplinary – conceived and led by urologists with little input from outside fields, urology research of the future must incorporate a much broader set of perspectives, including public health, behavioral medicine, geriatrics, microbiology, and psychology, among many, many others. Urology research of the future must also look beyond the lower urinary tract for potential contributing factors to UI and other LUTS. We must explore local and systemic biology, behavior, cognitive function and social determinants of health. 

This vision of future urology research has been informed by discussion with clinicians and researchers at meetings and workshops. First, participants at the March 2014 Summit on Urinary Incontinence Clinical Research in Women highlighted challenges with existing treatments and called for research focused on early disease, risk factor identification, better phenotyping, incorporation of new technologies, patient centered research and prevention.2 Then, those who joined the March 2015 Workshop on Behavioral and Psychosocial Factors in Women with Urinary Incontinence—which led to the development of the Non-biologic factors that impact management in women with urinary incontinence manuscript—identified numerous factors that might interfere with UI treatment across the process of seeking and receiving care, and called for comprehensive, interdisciplinary research approaches to understand contributors to effective UI treatment.

Most recently, urology clinicians and researchers convened at the Individualizing Treatment - Broadening the Framework for Urinary Incontinence Research meeting in March 2017 to begin to develop fundable, interdisciplinary, investigator-initiated research proposals targeting to improve success of existing treatments by individualizing them to each patient.3 This research proposal development process will be continued at a follow up meeting, Individualizing Treatment for Urinary Incontinence – Evolving Research Questions into Research Plans, to be held in February 2018. 

We anticipate this evolution of urology research will ultimately enable personalized approaches to the treatment of UI and other LUTS, ultimately enabling clinicians and individuals to identify the right treatment, for the right person, at the right time.   

Written By: Jenna M Norton, Tamara G Bavendam

Read the Abstract


References
1. Bavendam TG, Norton JM, Kirkali Z, et al. Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms. The Journal of urology 196(5):1342 (2016).

2. Chai TC, Asfaw TS, Baker JE, et al. Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women. The Journal of urology 198(1):22 (2017).

3. National Institute of Diabetes and Digestive and Kidney Diseases. Individualizing Treatment - Broadening the Framework for Urinary Incontinence Research Meeting Minutes. https://www.niddk.nih.gov/news/events-calendar/Pages/Individualizing-Treatment-Broadening-the-Framework-for-Urinary-Incontinence-Research.aspx.
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