405 476
incontinence) during PFS. The reduced sensation of the
ability to detect the fullness of the bladder was described by
a minority of patients (
n
= 5, 11%).
[9_TD$DIFF]
‘‘
I’m getting up every night two or three times, average twice
a night and not getting very good sleep
’’
[10_TD$DIFF]
‘‘
Just constantly going back and to and from the toilet
’’
[11_TD$DIFF]
‘‘
I can feel it coming on and then all of a sudden I think gosh
I’ve got to go
’’
3.2.
Voiding symptoms
The voiding symptoms described by the majority of patients
(
>
50%) included a slow stream, hesitancy, and straining.
These were often spontaneously reported by either sex with
high degree of associated bother. The combination of these
symptoms in individual patients could result in extended
voiding time and lengthy stays in the bathroom. The
strength of the urinary stream was described as ‘‘slow’’ or
‘‘weak,’’ and could be unpredictable or variable. Patients
described ‘‘having to wait’’ or ‘‘concentrate’’ before the
urine flow would begin, usually for a few seconds but was
up to 20 min in one male patient. Straining could be
described as ‘‘pushing’’ or ‘‘squeezing’’ and was used to
initiate or maintain the flow, or to try and make sure the
bladder was empty at the end of micturition. An intermit-
tent stream, spraying of the flow (in men) and urinations of
small volume per void were also reported.
[12_TD$DIFF]
‘‘
Stopping and starting with a very weak flow, then I could
stand in front of the loo for at least three or four minutes and
nothing happens
’’
[13_TD$DIFF]
‘‘
It’s a combination of sort of mental and physical cajoling to
make it start
’’
[14_TD$DIFF]
‘‘
There would be very little natural flow and the majority of
the flow would be as a result of having to strain
’’
3.3.
Postmicturition symptoms
A sensation of incomplete emptying of the bladder (
n
= 19,
43%), often resulting in the need to revoid within a short
period of time was frequently described by patients in all
diagnostic groups. A postmicturition dribble was reported
almost exclusively by men in this sample (
n
= 17, 39%).
Lower urinary tract pain was reported by 25% of patients
(
n
= 11) but the accounts were variable with regard to the
type, source, and severity of pain experienced.
[14_TD$DIFF]
‘‘
I know I need to do more and I can’t. That seems to be the
biggest annoyance because I’ll have to go again in a short
period of time rather than a proper emptying of the bladder
’’
[15_TD$DIFF]
‘‘
Usually when I have put myself together again after I’ve
urinated I do a little bit again
’’
3.4.
Other signs or symptoms
Many of the patients were either currently or had
historically been performing self-catheterisation (
n
= 23,
52%), and had experienced recurrent urinary tract infections
for which they had sought treatment in the past (
n
= 17,
39%). Four patients from the DU diagnostic group described
occasional episodes where they were unable to perform a
volitional void, and they would return to pass urine
successfully a short time after. In isolated incidents, six
patients had acute retention episodes that required hospital
admission for catheterisation. A minority of patients (
n
= 8,
18%) had bowel issues (eg, constipation) and two female
patients noticed an association of these with the reported
severity of their LUTS.
[16_TD$DIFF]
‘‘
My biggest concern quite honestly is the catheter one way
and another, what with infections and so on
’’
[12_TD$DIFF]
‘‘
Now and again which is very rare I just cannot go. I can
actually go to the loo about four or five times and I just
cannot perform at all
’’
3.5.
Impact
The impact of their symptoms on quality of life was highly
variable among different individuals. Some described the
negative consequences on their lives, whilst others reported
relatively little inconvenience saying they had become
‘‘used to it’’ due to the chronic nature of their condition
(
n
= 12, 27%). In particular, the symptoms of high urinary
frequency, nocturnal voids, and urgency caused a reliance
on planning their daily activities around the location of
toilets (
n
= 27, 61%) and daytime somnolence as a result of
interrupted sleep (
n
= 14, 32%). The ensuing disruption to
social, work-life, or physical activities could be very
bothersome. The consequence was an impact on self-image
or confidence, feelings of embarrassment in certain situa-
tions, and impact on relationships with family and friends,
including sex-life for a minority of patients. The control of
fluid intake was one way patients often sought to manage
their symptoms (
n
= 15, 34%).
[17_TD$DIFF]
‘‘
It makes life uncomfortable, I’m always looking to be
somewhere near the loo so I can go if I need to
’’
[14_TD$DIFF]
I couldn’t start the urine flow very easily and I became a bit
embarrassed by that situation because I was just stood there
doing nothing
’’
[11_TD$DIFF]
‘‘
It does interfere with my social life, and sleep as well
’’
4.
Discussion
To our knowledge, this is the first study to explore and
document the patient reported experience of UAB, elicited
from a purposive sample of male and female patients with a
primary diagnosis of DU. The result is a comprehensive
patient-centred description of the symptoms, signs, and
impact of UAB, revealing the condition to be a myriad of
storage and voiding LUTS.
The storage symptoms of nocturia, high urinary frequen-
cy, urgency, and incontinence, and voiding symptoms of
slow stream, hesitancy, and straining were most commonly
reported by both male and female patients. Straining (to
initiate, maintain, or finish urination) is of particular note as
it was well represented in the DU diagnostic group and is
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 4 0 2 – 4 0 7
405