(Poster 01) Comorbidities Associated with Pelvic Floor Dysfunction in Patients with LUTS

Objectives: Myofascial Urinary Frequency Syndrome (MUFS), characterized by urinary frequency, incomplete bladder emptying without true retention, and persistent urge without urgency, accounts for one-third of urinary frequency cases. MUFS is driven by pelvic floor muscle dysfunction and responds to pelvic floor–focused rather than bladder-directed therapies, underscoring the need for timely diagnosis. The persistency index (PI) is a newly validated tool designed to identify patients with MUFS based on patient reported survey from three validated questionnaires: Pelvic Floor Distress Index (PFDI), Overactive Bladder Questionnaire (OAB-q), female Genitourinary Pain Index (GUPI). This study aimed to characterize MUFS within a large clinical cohort and evaluate associations between PI scores and clinical comorbidities to guide more personalized evaluations.

Methods: We conducted a retrospective cohort study of all adult females seen at a single center urogynecology practice between August 2022 and September 2024 for a variety of pelvic floor complaints. Intake questionnaires, and patient characteristics including demographics, comorbidities, and initial clinician diagnosis were analyzed. PI was calculated for all subjects (PI = PFDI5 (score 0-4) + GUPI5 (0-5) + GUPI2B (0 or 3) + 3 (if age < 50)). MUFS is designated as PI >= 7. Univariate analysis compared patients with and without MUFS. A multivariate logistic regression was computed to identify independent predictors associated with higher PI score. Adjusted odds ratios with 95% confidence intervals were reported, with statistical significance defined as p value < 0.05.

Results: Among 2533 patients, 762 (30%) met criteria for MUFS (PI >= 7). Women with MUFS were 49.2 years old (48-50.4), and on univariate analysis (Table 1) no significant differences in prevalence of diabetes (p = 0.14), chronic pain (p = 0.64) or autoimmune disorders (p = 0.22) between the PI and non-PI groups were found. Diagnosis of pelvic floor dysfunction (PFD) at initial visit (OR 3.27, p < 0.0001) was significantly associated with PI >= 7, further confirming the PI’s ability to accurately identify those with MUFS.
In the adjusted multivariate logistic model (Figure 2), diabetes (OR 1.50, p = 0.014), psychiatry diagnosis (OR: 1.25, p = 0.019) and PFD diagnosis (OR 3.11, p < 0.0001) were significantly associated with a PI >= 7. Whereas hypertension (OR 0.66, p = 0.0002) and parity (OR 0.82, p = 0.027) were significantly associated with a lower PI score.

Conclusions: MUFS is a prevalent and underrecognized cause of LUTS. The PI is an effective tool for identifying MUFS and correlates strongly with clinical diagnosis of PFD. Higher PI scores were also independently associated with diabetes, psychiatric history, two medical conditions which have potential to directly affect pelvic floor function through microvascular and neuropsychological mechanisms.
Figure 1: Adjusted odds ratio from multivariate logistic regression showing higher PI associated with PFD diagnosis, diabetes and psychiatric diagnosis.