Neurourology and Urodynamics 26:190^195 (2007) Relationships Among Symptoms, Bother, and Treatment Satisfaction in Overactive Bladder Patients Martin C. Michel, 1 * Matthias Oelke, 2 Mark Goepel, 3 Elmar Beck, 4 and Martin Burkart 5 1 Department of Pharmacology & Pharmacotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands 2 Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands 3 Department of Urology, Klinikum Niederberg,Velbert, Germany 4 Anfomed Gmbh, Erlangen, Germany 5 P¢zer Pharma GmbH, Karlsruhe, Germany Aims: We have studied the association between various symptoms, bother, and patient treatment satisfaction in overactive bladder (OAB). Methods: Episodes of urgency, incontinence, daytime fre- quency and nocturia and responses to the patient perception of bladder condition scale, the urgency perception scale, and visual analog scales of limitations in daily life and of treatment satisfaction were evaluated in 3,824 OAB patients at baseline and during 9 months treatment with tolterodine ER (4 mg q.d.) in an open-label, observational study. Relationships amongst number of symptoms/ 24 hr and scales were explored. Treatment satisfaction was correlated with improvements in symp- toms and scales. Results: At baseline, the number of episodes of the four OAB symptoms correlated only poorly with each other and with the two bother-related scales, while the two scales assessing bother correlated much stronger with each other. Factor analysis identi¢ed four components which described ‘‘bother,’’ ‘‘incontinence,’’ ‘‘urgency/frequency,’’and ‘‘nocturia’’and in combination explained 81.9% of the total variance. The component ‘‘bother’’ had the strongest individual e¡ect accounting for 42.1% of the total variance. While improvements of symptoms and bother were seen with tolterodine treatment, patient treatment satisfaction correlated strongest with improvements of the two bother- related scales. Conclusions: We conclude that the counting of episodes of OAB symptoms only insu⁄ciently describes the a¥icted patients. Patient bother is the strongest individual component but only poorly explained by episodes of the four symptoms de¢ning OAB. Alterations of bother may better re£ect patient-relevant outcomes in OAB treatment than alterations in the number of symptom episodes. Neurourol. Urodynam. 26:190 ^195, 2007. ß 2006 Wiley-Liss, Inc. Key words: bother; factor analysis; overactive bladder; symptom scales; tolterodine; treat- ment satisfaction INTRODUCTION Overactive bladder syndrome (OAB) is a widespread condition a¥icting about 16% of the adult population [Milsom et al., 2001; Stewart et al., 2003]. The International Continence Society de¢nes OAB as a syndrome of urgency, with or without incontinence, usually accompanied by fre- quency and nocturia [Abrams et al., 2002]. Most previous stu- dies have assessed the severity of OAB and its improvement with treatment based upon the symptoms of incontinence or, subsequently, frequency [Herbison et al., 2003]. E¡ects of drugs on urgency and nocturia have only been studied more recently [Michel and de la Rosette, 2005; Rackley et al., 2006].The condition’s severities at baseline and post-treatment have mostly been described by counting the episodes of these symptoms per day or week. However, there is a growing con- cern whether such counting of OAB symptom episodes ade- quately re£ects patient perceptions and needs [Chapple et al., 2005]. This is re£ected in the recent introduction of various Dr. Michel has received research support, consultant fees and/or lecturer honoraria from 4SC, Astellas, Boehringer Ingelheim, Eli Lilly Co., P¢zer, and Theravance. Matthias Oelke has received lecturer honoraria from Boehringer Ingelheim and Eli Lilly Co. Dr. Goepel has received lecturer honoraria from P¢zer. Dr. Beck is an employee of Anfomed, which is a con- tract organization working for P¢zer. Dr. Burkart is an employee of P¢zer, the company making and selling tolterodine and which has sponsored the underlying study. The study was sponsored by P¢zer and was accepted for publication through a blinded independent peer review process. The reviewers were not informed about the potential con£ict of interest. The analysis of the study and statistical advice was provided by P¢zer. *Correspondence to: Martin C. Michel, Academisch Medisch Centrum, Afd. Farmacologie en Farmacotherapie, Meibergdreef 15, 1105 AZ Amster- dam,The Netherlands. E-mail: m.c.michel@amc.uva.nl Received 12 July 2006; Accepted 15 September 2006 Published online 9 November 2006 inWiley InterScience (www.interscience.wiley.com) DOI 10.1002/nau.20367 ß 2006Wiley-Liss,Inc.