Lower Urinary Tract Symptoms in the Danish Population: A Population-Based Study of Symptom Prevalence, Health-Care Seeking Behavior and Prevalence of Treatment in Elderly Males and Females

The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study

OBJECTIVE

To estimate and compare the prevalence and associated bother of lower urinary tract symptoms (LUTS) in the general populations of the USA, UK and Sweden using current International Continence Society (ICS) definitions, as no previous population-based studies evaluating the prevalence of LUTS in the USA, using the 2002 ICS definitions, have been conducted.

SUBJECTS AND METHODS

This cross-sectional, population-representative survey was conducted via the Internet in the USA, the UK and Sweden. Members of Internet-based panels were randomly selected to receive an e-mailed invitation to participate. If interested, respondents selected a link to an informed consent page, followed by the survey. Participants were asked to rate how often they experienced individual LUTS during the previous 4 weeks, on a five-point Likert scale, and, if experienced, how much the symptom bothered them. Descriptive statistics were used to summarize and present the data.

RESULTS

Responses rates for the USA, the UK and Sweden were 59.6%, 60.6% and 52.3%, respectively, with a final sample of 30,000 (USA 20,000; UK 7500; Sweden 2500). The mean age (range) of the participants was 56.6 (40-99) years; the mean percentages for race were 82.9% white, 6.7% black, 6.0% Hispanic and 4.4% Asian/other. The prevalence of LUTS was defined by two symptom frequency thresholds, i.e. at least 'sometimes' and at least 'often' for all LUTS except incontinence, where frequency thresholds were at least 'a few times per month' and at least 'a few times per week'. The prevalence of at least one LUTS at least 'sometimes' was 72.3% for men and 76.3% for women, and 47.9% and 52.5% for at least 'often' for men and women, respectively. For most LUTS, at least half of the participants were bothered 'somewhat' or more using a frequency threshold of at least 'sometimes'. For a threshold of at least 'often', 'somewhat' or more bother was reported by > or =70% of participants except for terminal dribble in men and split stream in women.

CONCLUSION

In this large population study of three countries, LUTS are highly prevalent among men and women aged >40 years. In general, LUTS experienced 'often' or more are bothersome to most people.

Chronic pelvic pain and lower urinary tract symptoms in both sexes: analysis of 2749 participants of an urban health screening project

BACKGROUND

Recent studies question the role of the prostate as the key factor in the pathogenesis of chronic pelvic pain syndrome (CPPS).

OBJECTIVE

To compare symptoms related to CPPS and lower urinary tract symptoms (LUTS) in both sexes.

DESIGN, SETTING, AND PARTICIPANTS

Participants of a voluntary health examination in Vienna.

INTERVENTION AND MEASUREMENTS

All participants completed a detailed questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), with the female homolog of each male anatomical term use on questionnaires for female participants, the International Prostate Symptom Score (IPSS), and additional questions on pelvic pain. Furthermore, all participants underwent a detailed health investigation performed by a general practitioner.

RESULTS AND LIMITATIONS

The study cohort comprised 1768 men and 981 women. The mean NIH-CPSI was 7.2+/-0.1 in women and 3.8+/-0.2 in men (p<0.001). In subject up to the age of 70 yr, the NIH-CPSI was higher in women (p<0.001). The NIH-CPSI increased with age in men (p<0.001), yet not in women (p=0.4). The prevalence of symptoms suggestive of CPPS in this selected population was 5.7% in women and 2.7% in men, and was higher in premenopausal women (p=0.03). Until the age of 50 yr, NIH-CPSI pain score in women exceeded that of men (p<0.001). The mean IPSS was higher in women (p<0.001). Storage symptoms were higher in women up to 60 yr, and voiding symptoms were higher in men above 60 yr. In men and women with symptoms suggestive of CPPS, the mean IPSS was significantly higher compared with those without CPPS symptoms (p<0.001). Limitations of our study are (1) that a urological evaluation was not performed and (2) that the questionnaire was not formerly validated for females.

CONCLUSION

The preponderance of CPPS in females raises questions about the etiological role of the prostate in all cases with chronic pelvic pain and suggests that other pathomechanisms are likely to be involved.

Symptom bother and health care-seeking behavior among individuals with overactive bladder

OBJECTIVE

To estimate symptom bother and health care seeking among individuals with overactive bladder (OAB; ie, cases) using current International Continence Society definitions.

METHODS

This was a nested case-controlled analysis of data from the EPIC study, a population-based, cross-sectional survey of adults in five countries. Cases and matched controls were asked about risk factors, use of coping techniques, and health care seeking for urinary symptoms. Cases were asked about symptom bother and assessed with the Overactive Bladder-Validated 8 and Patient Perception of Bladder Condition instruments.

RESULTS

Among cases (n=1434), 54% reported symptom bother; rates were similar between men (54%) and women (53%). Significantly more men with urinary incontinence (UI) reported bother (77%) than women with UI (67%; p<or=0.05). Among cases with UI who reported bother, more women (73%) than men (51%) used a urinary symptom coping technique, and the proportions were significantly greater than controls (men: 10%; women: 15%; p<or=0.05 for cases with UI vs. controls). Among cases using coping techniques, 63% of men and 69% of women initiated a conversation with a health care provider. Initiation of conversation with a health care provider was highest among cases who had a doctor visit within 6 mo (odds ratio [OR], 2.8), used coping techniques (OR, 2.2), or reported symptom bother (OR, 2.2).

CONCLUSIONS

Cases reporting symptom bother, particularly those with UI, were significantly more likely to use coping techniques and seek health care advice. Clinicians should screen for OAB in all cases and assess symptom bother in those affected to guide diagnosis and treatment.

The Natural History of Lower Urinary Tract Symptoms in Females: Analysis of a Health Screening Project

OBJECTIVE

To analyse over 6.5 yr the natural history of lower urinary tract symptoms (LUTS) of continent women participating in a health investigation.

METHODS

Women participating in a health screening survey in the area of Vienna in 1998-1999 underwent a detailed health investigation and completed the Bristol Female LUTS questionnaire. In 2005, all women still living in the area of Vienna were contacted by mail to complete the Bristol LUTS questionnaire again. For the current study, only women without urinary incontinence at baseline and follow-up were eligible.

RESULTS

A total of 223 women (mean age, 50.3 yr; range, 21-79) were included in this 6.5-yr longitudinal study. At baseline, 80 women (35.9%) reported LUTS; this number increased to 105 (47.1%) 6.5 yr later. The calculated mean annual incidence of LUTS was 5.3% and revealed no clear dependency on age: 20-39 yr, 5.6%; 40-59 yr, 5.9%; > or =60 yr, 3.7%. The mean annual remission rate of LUTS was 4.6% without clear age dependency. Symptoms most likely to improve were "urgency"; "frequency"; "nocturia" and "feeling of incomplete bladder emptying" had the highest tendency of worsening.

CONCLUSIONS

This longitudinal study on the natural history of LUTS in women without urinary incontinence provides estimates for incidence and remission rates over 6.5 yr. Compared with men, LUTS in women are a dynamic rather than a necessarily progressive disorder.

Prevalence of storage and voiding symptoms among men aged 40 years and older in a US population-based study: results from the Male Attitudes Regarding Sexual Health study

AIMS

Lower urinary tract symptoms (LUTS) are categorised as storage (urgency, frequency, nocturia and incontinence), voiding (sensation of incomplete emptying, hesitancy, weak stream and straining) or mixed symptoms.

METHODS

In this US population-based study, we investigated the prevalence of male LUTS and the relative frequency of the LUTS subtypes, and we evaluated associations between LUTS and age, race/ethnicity and erectile dysfunction (ED). The Male Attitudes Regarding Sexual Health study included a nationally representative sample of non-Hispanic black, non-Hispanic white and Hispanic men aged>or=40 years. Participants completed a questionnaire including items on ED and the International Prostate Symptom Score (IPSS). The prevalence and subtypes of LUTS were investigated post hoc by age, race/ethnicity and the presence of ED.

RESULTS

The overall prevalence rates of storage (13%) and mixed (9%) symptoms were higher than that of voiding symptoms (6%). The prevalence of storage symptoms was similar across age groups, whereas voiding and mixed symptoms increased with age. Among men with IPSS>or=8, the rates of storage (29%) and mixed (38%) symptoms were also higher than voiding symptoms (23%). Distributions of the LUTS subtypes were comparable among black, white and Hispanic respondents with IPSS>or=8. The overall prevalence rate of ED (40%) increased with age among those with IPSS>or=8. Isolated storage symptoms were more than twice as common as isolated voiding symptoms among US men>or=40 years of age.

CONCLUSION

Careful attention to individual symptoms may help distinguish storage LUTS from voiding LUTS, a distinction that has important implications for treatment.

An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey

OBJECTIVES

To investigate whether circulating levels of sex hormones are associated with urological symptoms, using data from the Boston Area Community Health (BACH) Survey.

SUBJECTS AND METHODS

BACH used a multistage stratified-cluster approach to randomly sample 5506 adults aged 30-79 years in Boston, MA, USA. Anthropometric measures, lifestyle and psychosocial factors, comorbidities and urological symptoms were obtained using a questionnaire administered by an interviewer. Serum testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), dihydrotestosterone (DHT) and oestradiol (E2) levels were measured, and bioavailable testosterone (BT) was calculated in 1899 men (538 Black, 651 Hispanic and 710 White). Regression analysis was used to investigate the relationships between androgen levels and American Urological Association symptom index (AUA-SI), lower urinary tract symptoms (LUTS) (> or = 8 on the AUA-SI), urinary incontinence (UI), dribble and hesitancy.

RESULTS

Of all subjects, 19% reported LUTS, 6% UI, 9% dribble and 4% hesitancy. Testosterone, BT and DHEAS levels were inversely related to the AUA-SI (P = 0.009, <0.001 and <0.001, respectively); SHBG values and the AUA-SI were positively correlated (P < 0.001). Adjusting for age, BT and DHEAS levels had negative relationships with the AUA-SI; BT and DHEAS levels were negatively related to LUTS and SHBG was positively related to LUTS (both P < 0.001); after age adjustment, only LUTS and DHEAS remained related, and only the relationship between dribble and E2 remained significant; no hormone levels were related to hesitancy.

CONCLUSIONS

Circulating levels of sex hormones are generally not significant predictors of urological symptoms in men after adjusting for age. The pathophysiology of LUTS is complex and probably includes factors other than circulating sex steroid levels.

Prevalence of urinary frequency in Taiwanese women aged 20-59 years

OBJECTIVE

To evaluate the prevalence of daytime urinary frequency among Taiwanese women aged 20-59 years.

MATERIALS AND METHODS

In 1998, there were an estimated 5.9 million female residents aged 20-59 years in Taiwan. A random sample of 4,549 women was chosen by multistage sampling. Face-to-face visits with 3,537 women were completed by trained professional interviewers within 3 months of the subjects' selection. Questions about lower urinary tract symptoms, sociodemographics, reproduction, and medical and surgical histories were recorded. The factors were assessed by frequency and logistic regression analyses using a significance level of less than 0.05.

RESULTS

The prevalence of urinary frequency in Taiwanese women aged 20-59 years was 5.2% (182/3,519); 18 interviewees did not answer the question about frequency and were excluded. For those who complained of frequency, 47.2% voided 8-15 times a day, 37.4% voided 16-23 times a day, 1.1% voided 24-31 times a day and 14.3% voided more than 31 times a day. The prevalence of urinary frequency was not linked to age (p = 0.326).

CONCLUSION

Urinary frequency is a common symptom in women of all ages and is not significantly related to age. More than half of the women interviewed admitted that less than an hour occurred between visits to the restroom during the daytime.

Determinants of Seeking of Primary Care for Lower Urinary Tract Symptoms: The Krimpen Study in Community-Dwelling Men

OBJECTIVES

To determine which factors predict seeking of primary care among men with lower urinary tract symptoms (LUTS).

METHODS

A longitudinal, population-based study with a follow-up period of 6.5 yr was conducted among 1688 men aged 50-78 yr. The following data were collected: prostate volume (using transrectal ultrasonometry), urinary flow rate, ultrasound-estimated postvoid residual urine volume, generic and disease-specific quality of life (QOL), and symptom severity (International Prostate Symptom Score [IPSS]). Information on the seeking of primary care by all participants during 2 yr of follow-up was collected from the general practitioner's (GP) record using a computerised search engine and a manual check of electronically selected files.

RESULTS

Prostate volume, postvoid residual volume, IPSS, and social generic QOL are important determinants of first GP consultation in men with LUTS. Measurements (physical urologic parameters) and self-reported items (symptom severity and QOL) contribute almost equally to GP consultation in these men.

CONCLUSIONS

Both measurements of prostate volume and postvoid residual urine volume and self-reported information about symptoms or QOL can help to select those who will benefit from medical care and to reassure those men not likely to need help in the near future.