UroToday - "Urgency" is the cornerstone of the diagnosis of overactive bladder (OAB) as well as a common complaint of patients with BPS/IC. What the term actually refers to when used by patients remains problematic and the subject of some controversy. The International Continence Society defines it as a "sudden compelling desire to void that is difficult to defer". The word sudden is designed to differentiate the sensation from the "urgency" that patients with BPS/IC complain of, but the distinction is quite vague in practice. Many believe that it is the reason for the urgency (fear of incontinence vs. pain) that should make the distinction.

Dr. Jerry Blaivas and colleagues from New York City published an interesting study detailing the results of a survey administered to 48 consecutive patients who complained of urinary urgency. The survey was validated by administering 2 different questionnaires. Each group of 24 patients received one questionnaire twice (for test/retest reliability) and also received the other questionnaire. For questionnaire #1 the urge sensation was an intensification of the normal sensation for 68% of patients and it was a different sensation for 31%. For questionnaire #2, it was an intensification of the normal urge in 71% and different in 29%. In the crossover section only 1 of 48 subjects changed their response.

Blaivas points out that some authors believe that urgency is like a light switch; it is either on or off and cannot be graded. It differs from urge, which is a normal physiologic sensation. This distinction has been based on expert opinion. The authors' data suggests that urgency is comprised of at least two different sensations in the OAB population. One is an intensification of the normal urge to void, and the other is an altogether different sensation. In the over two-thirds who experience the first type, grading of urgency should be possible and the light-switch theory would not hold.

If one includes the urgency described by the BPS/IC patients, the situation becomes even more complex. One word may not do justice to what we or our patients are trying to describe, and better definitions and terminology may be required to facilitate a proper history and basic and clinical research studies.

Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C
Neurourol Urodyn. 2009;28(3):188-90.
doi: 10.1002/nau.20525

UroToday Contributing Editor Philip M. Hanno, MD, MPH

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