Due to the anatomical proximity of the bladder and uterus it is thought that women with uterine fibroids may experience lower urinary tract symptoms (LUTS). It has been suggested that uterine fibroids can be associated with urinary urgency, urge and stress incontinence, dysuria, urinary retention, and voiding dysfunction [1].  Surgical management of uterine fibroids over 7cm can result in significant improvement in LUTS in most women [2].  However, the relationship between smaller fibroids, uterine volume, and LUTS is more variable [3]. 
Health-related Quality of Life Questionnaires are useful tools to help us understand the impact of disease of our patients.  One widely used validated tool to help assess the effect urinary symptoms on patients’ quality of life is the King’s Health Questionnaire (KHQ). The aim of this study is to understand the relationship between total fibroid volume and uterine volume on LUTS and their effect on quality of life in women with fibroids and LUTS by asking women to fill out the KHQ.

We retrospectively analysed the MRI imaging and KHQ scores of women who had attended a busy tertiary level gynaecology department between 2015-2020. These women all presented with uterine fibroids for which they had undergone imaging with T2-weighted tri-planar MR images obtained at 1.5 T . The parallel planimetric method was used to calculate the total uterine volume (TUV) and volume of the largest fibroid (VolFib).  The total volume was automatically calculated by the Reportcard© software, using a summation of the adjacent volumes and application of interpolation formulae between slices. We calculated the scores for each domain of the validated King’s Health Questionnaire. Statistical analysis was performed using IBM SPSS Statistics version 29.

Seventy-six women were studied having both a mean and median age of 42 (range 21-76) and mean parity of 0.35 (range 0-2). The average TUV was 664.7cm3 and the average VolFib was 341.9cm3. 
We performed linear regression analysis and ANOVA to see how TUV and VolFib are related to each domain score of the KHQ. To ensure assumptions were met for linear regression, residual minimum and maximum values were between -3 and +3 showing no significant outliers, Durbin-Watson testing was between1 and 3 showing that the assumption of independence of observations was met, and histogram showed normal distribution. 
We found that VolFib had a statistically significant relationship with the score of domains 2, 4, 5, 7, 8, and the symptom severity score. Whereas TUV had statistically significant relationships with the scores of domains 7, 8, 9, and the symptom severity score. When then looking at the values of R-squared, VolFib showed significant impact on scores for incontinence impact (domain 2, R2=0.62), physical limitations (domain 4, R=0.61), sleep/energy (domain 8, R2=0.72), and symptom severity scores (R=0.107). Total uterine volume had lower R-squared values with the most significant being on sleep/energy (domain 8, R2= 0.62).

Total uterine volume (TUV) and fibroid volume (VolFib) both correlate with statistical significance to multiple domain scores on the King’s Health Questionnaire. 
TUV correlates with statistical significance to six domains and VolFib to four domains. When looking at the values of R2, VolFib had greater values when compared with TUV and therefore had a greater influence on score outcomes. The greatest R2 values were seen for domains: 2) incontinence impact, 4) physical limitations, 8) sleep/energy, and the symptom severity scores. The largest R2 value was 0.72 for domain 8) sleep/energy, demonstrating that 72% of scores in this domain were impacted by VolFib. Interestingly, the largest R2 for TUV was also seen for domain 8), where R2=0.62. 

Our results show that with larger fibroid volumes and larger uterine volumes patients report greater severity of lower urinary tract symptoms, and more negative impact on quality of life. We found that fibroid volume had a larger effect on scores in the KHQ domains.

This is the first study evaluating uterine volume and fibroid volume on MRI with lower urinary tract symptoms and quality of life measures. We have found that both total uterine volume and fibroid volume correlate with statistical significance to domain scores in the King’s Health Questionnaire. We have demonstrated that larger uterine and fibroid volumes are associated with more severe lower urinary tract symptoms, and more negative impact on quality of life. This study has shown that fibroid volume has a greater influence on scores in more domains than uterine volume.

Bochenska Lewitt, Marsh, Pidaparti, Lewicky-Gaupp, Mueller, Kenton. Fibroids and Urinary Symptoms Study (FUSS). Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):e481-e483
Cvach, Dwyer, Rosamilia, Lim, Schierlitz. A prospective study of lower urinary tract symptoms before and after surgical removal of a large pelvic mass. Int Urogynecol J. 2015 Feb;26(2):201-6.
Mourgues, Villot, Thubert, Fauvet, Pizzoferrato. Uterine myomas and lower urinary tract dysfunctions: A literature review. J Gynecol Obstet Hum Reprod. 2019 Nov;48(9):771-774.

Continence 12S (2024) 101438
DOI: 10.1016/j.cont.2024.101438