ORIGINAL ARTICLE Development and psychometric evaluation of the urgency questionnaire for evaluating severity and health-related quality of life impact of urinary urgency in overactive bladder Karin S. Coyne & Chris C. Sexton & Christine Thompson & Tamara Bavendam & Linda Brubaker Received: 6 November 2013 /Accepted: 3 May 2014 # The International Urogynecological Association 2014 Abstract Introduction and hypothesis Urinary urgency is the cardinal symptom of overactive bladder (OAB). However, there is no single instrument that assesses the context, severity, intensity, and daily life impact of urinary urgency. The purpose of this manuscript is to describe the methods and results of the qualitative and quantitative research conducted to develop a new tool for this purpose, the Urgency Questionnaire (UQ). Methods Qualitative data from interviews with patients with urinary urgency were used to develop and refine the items and response options of the UQ. Three studies were used to evaluate psychometric properties: a clinical trial of tolterodine (Detrol; n =974); a psychometric validation study (n =163); and a test–retest validation study (n =47). Item and explorato- ry factor analysis (EFA) were performed to assess the subscale structure, and the psychometric performance of the resulting scales was evaluated. Results Fifteen Likert-scale items and four VAS questions were retained. A four-factor solution was shown to best fit the data, with the subscales: Impact on Daily Activities, Time to Control Urgency, Nocturia, and Fear of Incontinence. All subscales and VAS items demonstrated good reliability (Cronbach’s α 0.79–0.94), convergent and discriminant va- lidity, and responsiveness to change. The UQ differentiated between OAB patients and controls. Conclusion The results provide quantitative evidence that urinary urgency, as assessed by the UQ, is a pathological sensation distinctive from the normal urge to void and suggest that the UQ might be a reliable, valid, and responsive instru- ment for evaluating the severity and HRQL impact of urinary urgency in OAB. Keywords OAB . Qualitative . Questionnaire . Urinary urgency . Validation . Symptoms . HRQL Introduction Overactive bladder (OAB) is the symptom complex of urinary urgency (UU), usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of urinary tract infection or other obvi- ous pathology [1]. High rates of OAB prevalence have been documented globally. Estimates of the prevalence across gen- der from the European and Canadian EPIC [2] and United States (US) NOBLE [3] studies ranged from 12 to 27 % [2, 3]. Recent gender-specific estimates in the US, United Kingdom (UK) and Sweden from the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) study among adults aged 40 and older were even higher, ranging from 16 to 27 % in men and 33 to 43 % in women, depending on the severity cut-off point used to define presence [4]. About one-third (33 %) of patients with OAB experience urgency incontinence (“OAB wet”), while 66 % have OAB without urgency incontinence (“OAB dry”)[5]. The symptoms of OAB can affect social, psychological, occupational, physical, relational, and sexual aspects of life [5]. Qualitative research with men and women with OAB suggests that UU might be the symptom with the greatest impact on patients’ daily lives and night-time sleep and can result in considerable anxiety and feelings of depression [6]. K. S. Coyne (*) : C. C. Sexton : C. Thompson Evidera, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA e-mail: karin.coyne@evidera.com T. Bavendam NIDDK/National Institutes of Health, Bethesda, MD, USA L. Brubaker Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA Int Urogynecol J DOI 10.1007/s00192-014-2435-5