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Causal diagram-derived phenotypes of urinary urgency and urgency incontinence: a matter of degree rather than distinct categories
Journal article   Open access   Peer reviewed

Causal diagram-derived phenotypes of urinary urgency and urgency incontinence: a matter of degree rather than distinct categories

J. Eric Jelovsek, Cindy L. Amundsen, Victor P. Andreev, M. Alan Brookhart, Aaron Lentz, Tara Morgan, Brian Bieber, Nathan P. Goodrich, Ziya Kirkali, Catherine S. Bradley, …
Continence (Amsterdam), 102834
09/2026
DOI: 10.1016/j.cont.2026.102834
url
https://doi.org/10.1016/j.cont.2026.102834View
Published (Version of record) Open Access

Abstract

Background and Objective To identify phenotypes of urinary urgency (URG) and urgency incontinence (UUI) from expert causal knowledge summarized as directed acyclic graphs (DAGs), and to determine whether they are discrete classes or probabilistic positions on a continuum. Methods DAGs representing clinical phenotypes were constructed from knowledge elicited from urologists and urogynecologists. Ninety LURN II participants served as phenotype anchors; the remaining 539 were assigned to the nearest centroid. Compactness was each participant's distance to their centroid relative to median between-centroid distance. Validity was the prognostic information phenotypes added for symptom severity at 3 and 12 months beyond baseline severity. Key Findings and Limitations 629 participants (336 females, 293 males) were assigned to eight phenotypes: polyuria (n=265), nocturnal polyuria (n=129), metabolic (n=96), affective (n=41), bowel and bladder dysfunction (n=22), pelvic organ prolapse (n=19, females), UTI (n=4, females), and benign prostatic enlargement (n=53, males). Continuous position was more informative than categorical labels: adjusted for baseline severity, distances added 9–18% of new prognostic information beyond labels, labels only 3–9% beyond distances, across strata. No participant met the 0.20 compactness threshold (smallest ratio 0.73 in women, 0.68 in men); baseline severity alone remained more prognostic than the phenotypes. Conclusions and Clinical Implications URG/UUI patients can be described by eight DAG-derived phenotypes, but these are probabilistic positions, not discrete classes. Continuous representations retained modestly more prognostic information than labels, though both added little beyond baseline severity. These phenotypes are interpretable but not yet suitable for clinical use.

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