Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis

BACKGROUND AND OBJECTIVES

Acute uncomplicated cystitis (AC) is common among women. Acute onset of specific typical symptoms may serve as reliable criteria for developing a cost-effective strategy to make an accurate diagnosis of AC. We aimed to evaluate the diagnostic values of most common symptoms and signs of AC depending on their presence and severity.

METHODS

The current trial was designed as a case-control study. Data derived from the Acute Cystitis Symptom Score (ACSS) database were analyzed. Diagnostic values of the symptoms and their severity were assessed via the calculations of the sensitivity and specificity, odds ratio, positive and negative likelihood ratios. The strength of associations was estimated by the coefficient of correlation (Pearson's R).

RESULTS

Data from 819 female subjects (423 Patients, 396 controls) with the mean age of 37.1 ± 15.3 were analyzed. Highest diagnostic values for AC in this study belonged to dysuria, urgency, and frequency. Interestingly, complaints of vaginal discharge was not found to decrease the odds for having AC in the study population.

CONCLUSIONS

The severity of the symptom is even more essential than just its presence for an accurate diagnosis. The ACSS is an accurate tool and may be recommended for clinical practice and studies for diagnosis of AC in women. Further studies and unification of terms are need.

Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part II. Patient-Reported Outcome Assessment

This study aimed to reevaluate the Acute Cystitis Symptom Score (ACSS). The ACSS is a self-reporting questionnaire for the clinical diagnosis of acute uncomplicated cystitis (AC) and the assessment of symptomatic changes after therapy in female patients with AC. The part II of the present study was to reevaluate the utility of the different domains of the ACSS after therapy. The applicability of these domains in assessing changes in symptoms, as a function of time, in this population was investigated. The ACSS was evaluated in 48 female patients (mean age 31.1 ± 10.6) in the Uzbek and Russian languages, who returned after therapy and filled in part B of the ACSS, which corresponds to part A with the additional “Dynamics” domain. Descriptive statistics were used, where suitable. The reduction of typical symptoms and quality of life assessment between first and follow-up visit correlated significantly with answers in the “Dynamics” domain. Success/Cure and Non-success/Failure could be clearly differentiated by the scores obtained in “Typical” and “Quality of Life” domains. The ACSS has proven to be a useful instrument to clinically diagnose AC in women. It is also a suitable instrument for patient-reported outcome measures, with applicability both in daily practice and clinical studies. Slight modifications in the “Dynamics” domain will even increase the applicability.

The Acute Cystitis Symptom Score for Patient-Reported Outcome Assessment

OBJECTIVES

The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for clinical diagnosis of acute uncomplicated cystitis (AUC) and symptomatic changes in female patients. The aim of the present study was to assess the utility of the different domains of ACSS including the 'dynamics' domain after therapy. The applicability of these domains in assessing changes in symptoms, as a function of time, in this population was investigated.

MATERIALS AND METHODS

During the validation process of the ACSS in Uzbek and Russian languages, a subgroup of patients (n = 63) returned after therapy and filled in part B of ACSS. Descriptive statistics were used, where suitable.

RESULTS

The reduction of typical symptoms and quality of life (QoL) assessment between first and follow-up visit correlated significantly with answers in the 'dynamics' domain. Success/cure and non-success/failure could be clearly differentiated by the scores obtained in 'typical' and 'QoL' domains.

CONCLUSION

The ACSS has proven to be a useful instrument to clinically diagnose AUC in women. It is also a suitable instrument for patient-reported outcome assessment, with applicability in both daily practice and in clinical studies. Slight modifications in the 'dynamics' domain will even increase the applicability.

[German validation of the Acute Cystitis Symptom Score]

BACKGROUND

The Uzbek version of the Acute Cystitis Symptom Score (ACSS) was developed as a simple self-reporting questionnaire to improve diagnosis and therapy of women with acute cystitis (AC). The purpose of this work was to validate the ACSS in the German language.

MATERIALS AND METHODS

The ACSS consists of 18 questions in four subscales: (1) typical symptoms, (2) differential diagnosis, (3) quality of life, and (4) additional circumstances. Translation of the ACSS into German was performed according to international guidelines. For the validation process 36 German-speaking women (age: 18-90 years), with and without symptoms of AC, were included in the study. Classification of participants into two groups (patients or controls) was based on the presence or absence of typical symptoms and significant bacteriuria (≥ 10(3) CFU/ml). Statistical evaluations of reliability, validity, and predictive ability were performed. ROC curve analysis was performed to assess sensitivity and specificity of ACSS and its subscales. The Mann-Whitney's U test and t-test were used to compare the scores of the groups.

RESULTS

Of the 36 German-speaking women (age: 40 ± 19 years), 19 were diagnosed with AC (patient group), while 17 women served as controls. Cronbach's α for the German ACSS total scale was 0.87. A threshold score of ≥ 6 points in category 1 (typical symptoms) significantly predicted AC (sensitivity 94.7%, specificity 82.4%). There were no significant differences in ACSS scores in patients and controls compared to the original Uzbek version of the ACSS.

CONCLUSION

The German version of the ACSS showed a high reliability and validity. Therefore, the German version of the ACSS can be reliably used in clinical practice and research for diagnosis and therapeutic monitoring of patients suffering from AC.

[EVALUATION OF THE EFFICACY OF STANDARD PERCUTANEOUS NEPHROLITHOTRIPSY IN STAGHORN AND MULTIPLE NEPHROLITHIASIS]

In staghorn and multiple nephrolithiasis, method of choice for removing kidney stones is percutaneous nephrolithotripsy (PCNL). However, it may be accompanied by the leaving off of stones or fragments in pyelocaliceal system. The study was aimed to the evaluation of possibilities of the standard PCNL in terms of complete removal of staghorn and multiple kidney stones. Percutaneous nephrolithotripsy was made by a single access using standard method in 99 patients with staghorn and multiple kidney stones. The average age of the patients ranged from 9 to 61 (34.4±3.2) years. Staghorn stones were found in 80 (80.8%) patients, staghorn stones with multiple stones - in 19 (19.2%) patients. Stone size ranged from 18 to 94 (49.6±2.3) mm. The use of standard PCNL to remove staghorn and multiple kidney stones as monotherapy has allowed complete removing of the stones in 74 (74.7%) patients. The average length of stay of patients in hospital after surgery was 5.9±0.3 bed-days (2 to 31), medium time for removal of drains after surgery - 4.3±0.7 days. Intraoperative blood loss was observed in 11 (11.1%) patients, its volume ranged from 150 to 1130 (407.2±28.8) ml. In 8 (8.1%) cases, bleeding regarded as a complication, because it required replacement therapy. Postoperative complications were observed in 19 (19.2%) patients, of which 8 (8.1%) had bleeding, and 11 (11.1%) had exacerbation of urinary tract infection. Thus, the standard PCNL as monotherapy in staghorn and multiple nephrolithiasis serves as alternative method for removing stones. The results of treatment depend on the size and stereometric configuration of staghorn stones. The most common causes of residual stones are inaccessibility of calyx by endoscope and intraoperative bleeding.

[Development and clinical testing of the Russian version of the Acute Cystitis Symptom Score - ACSS]

The Acute Cystitis Symptom Score - ACSS was originally developed in the Uzbek language and has demonstrated high reliability and validity. The study was aimed to develop a Russian version of the ACSS questionnaire and evaluate its psychometric properties. Translation and adaptation of the ACSS questionnaire containing 18 questions, 6 of them - for the typical symptoms of acute cystitis (AC), 4 - for the differential diagnosis; 3 - for the quality of life, and 5 - for the conditions that may affect the choice of treatment, were performed according to the recommendations developed by the Mapi Research Institute. Study involved 83 Russian-speaking women (mean age, 35.6 ±13.7 years); 38 (45.8%) patients were in the main group (patients with AC), and 45 (54.2%) - in the control group (without AC). Medical examination and appropriate treatment of the respondents were conducted in accordance with approved standards. After completing the course of therapy, 19 (50%) patients of the main group came for the control examination. There was statistically significant difference in the scores obtained in the two groups. Score profiles positively correlated with the results of laboratory tests (rho = 0.26-0.48). Cronbach's alpha for the Russian version of the questionnaire was 0.86 (95% CI, 0.81-0.91), area under the curve in the ROC analysis was 0.96. The results of testing the Russian version correspond to those of the original version. The Russian version of the ACSS questionnaire has high. reliability and validity, and can be recommended for clinical research and diagnosis of primary AC, and dynamic monitoring of the effectiveness of the treatment of the Russian-speaking population of patients.

New self-reporting questionnaire to assess urinary tract infections and differential diagnosis: acute cystitis symptom score

OBJECTIVE

Development and validation of a simple and standardized self-reporting questionnaire for acute uncomplicated cystitis (AUC) assessing typical and differential symptoms, quality of life and possible changes after therapy in female patients with AUC.

MATERIALS AND METHODS

Literature research, development and evaluation of the Acute Cystitis Symptom Score (ACSS), an 18-item self-reporting questionnaire including (a) six questions about 'typical' symptoms of AUC, (b) four questions regarding differential diagnoses, (c) three questions on quality of life and (d) five questions on additional conditions which may affect therapy. The ACSS was evaluated in 286 women (mean age 32.3 ± 12.3 years) in the Russian and Uzbek language. Measurements of reliability, validity, predictive ability and responsiveness were performed.

RESULTS

Cronbach's alpha for the ACSS was 0.89, split-half reliability was 0.92 and correlation between halves was 0.85. Mann-Whitney test revealed significant difference scores of the 'typical' domain between patients and controls (10.75 vs. 2.02, p < 0.001). The optimal threshold score was 6 points, with a 94% sensitivity and 90% specificity to predict AUC. The symptom score decreased significantly when comparing before and after therapy (10.7 vs. 2.1, p < 0.001).

CONCLUSION

The new validated ACSS is accurate enough and can be recommended for clinical studies and practice for initial diagnosis and monitoring treatment of AUC. Evaluation in other languages is in progress.