Lack of group-to-individual generalizability in people with lower urinary tract symptoms emphasizes the need for deep phenotyping and personalized treatments

Introduction: Understanding how different symptoms co-occur and are correlated may provide insights into the pathophysiology of disease. The lack of group-to-individual generalizability of co-occurrence of symptoms was recently demonstrated by comparing intra-individual and inter-individual correlations in several psychological studies. Here, we investigate this phenomenon for lower urinary tract symptoms (LUTS). Methods: We analyzed data collected in the Symptoms of Lower Urinary Tract Dysfunction Research Network Recall Study. Participants responded to questions about their urinary symptoms for 25 consecutive days. These questions queried urologic symptoms including storage (urinary urgency, frequency, nocturia, and urinary incontinence), voiding (slow/weak stream), and post-micturition (incomplete emptying and post-micturition dribble) symptoms. We calculated Pearson correlation coefficients and cosine similarity measures and compared distributions of intra-individual and inter-individual (cohort) metrics. Results: Among 234 participants, distributions of intra-individual measures were 10-fold wider than those of inter-individual correlations. There are pairs of questions with distributions of correlations and cosine similarities containing individuals with extreme positive (>0.8) and extreme negative values (<–0.8). There are groups of participants with strong positive and negative correlations of urinary frequency and nocturia, urinary incontinence and weak flow, as well as strong negative and positive correlations of urinary frequency and dribbling. Information on these extreme groups is averaged out and lost in the inter-individual correlations. Conclusions: Lack of group-to-individual generalizability previously shown for psychological symptoms is confirmed for LUTS. Wealth of information on the co-occurrence and co-evolution of LUTS in the intra-individual correlations and cosine similarities corroborates heterogeneity of LUTS and can be useful for deep phenotyping and for identifying personalized treatments of LUTS.