NORTHWESTERN UNIVERSITY PLUS CLINICAL SITE

This is a proposal to create a model of risk for urinary symptoms within a consortium composed of multiple clinical sites and a data-coordinating center, to be known collectively as the Prevention of Lower Urinary Tract Symptoms in Women: Bladder Health Clinical Centers Consortium (PLUS). We assembled a diverse group of clinician/surgeon-scientists and translational researchers with expertise in 1) lower urinary tract symptoms (LUTS) and pelvic floor disorders in women, 2) impact of health behaviors such as diet and exercise, 3) comorbidities such as depression, anxiety and pain, 4) disease prevention and treatment, 5) clinical care of women, and 6) genetics. Our multidisciplinary team includes urogynecologists, urologists, gynecologists, psychologists, physical therapists, and geneticists with experience in clinical care and research of women at all stages of life. Our overarching aim is to investigate the relationship between environmental, psychosocial, and genetic factors that lead to the onset and progression of LUTS in women. In turn, this will facilitate the identification of target populations for LUTS prevention studies. In this proposal, we will (1) observe the incidence and progression of LUTS in a sample of women across stages of life, followed over a three-year longitudinal study, and (2) observe LUTS in reproductive age women around the time of pregnancy and delivery – a time associated with a sharp increase in LUTS – to determine predictive relationships between environmental, genetic, and psychosocial factors that lead to the onset and progression of LUTS in high-risk women. The finding from these studies will be used to identify target populations for disease prevention interventional studies. Our Specific Aim #1 is to study peripartum factors that confer risk for the incidence and progression of LUTS. Because pregnancy and delivery are associated with a sharp increase in LUTS, it is important to identify modifiable risk factors around this time to build a predictive model. This is particularly important because this is a time when women are in contact with the healthcare system, and therefore a time when intervention is possible. Specific Aim #2 is to determine psychosocial risk factors for LUTS. Dietary factors can contribute to LUTS, and psychological comorbidities (e.g., depression and anxiety) may exacerbate bother of these symptoms but also result in misdiagnoses of the underlying cause (LUTS). We will use brief, inexpensive, yet precise measures, highly amenable to epidemiologic research, to look for relationships between psychosocial factors and LUTS. Finally, Specific Aim #3 is to determine whether genetic factors confer risk for LUTS. Genetic risk may have a main effect on LUTS, but may also interact with peripartum and psychosocial factors.