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

Lower Urinary Tract Symptoms and Overactive Bladder in a Large Cohort of Older Poles-A Representative Tele-Survey

BACKGROUND

A reliable reference of population-based parameters for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) is lacking for the elderly. Thus, the objective of this study was to estimate the prevalence, bother, effect on quality of life, and treatment-related behavior for LUTS and OAB in a large population-level cohort of Polish adults aged ≥ 65 years.

METHODS

We used data from the telephone LUTS POLAND survey. Respondents were categorized by sex, age, and residence. All LUTS and OAB were assessed with validated questionnaires and a standard protocol based on the International Continence Society definitions.

RESULTS

The mean (standard deviation) age of 2402 participants (60.4% women) was 72.5 (6.7) years. The prevalence of LUTS was 79.5% (men: 76.6%; women: 81.4%), and the prevalence of OAB was 51.4% (men: 49.4%; women: 52.8%). The prevalence of both conditions increased with age. The most prevalent symptom was nocturia. LUTS and OAB were often bothersome, and almost half of participants who reported LUTS or OAB had decreased quality of life related to their urinary functioning. Nevertheless, only one third of participants sought treatment for their bladder problems, and most of these participants received treatment. We did not observe differences between urban and rural areas in all analyzed population-level parameters.

CONCLUSIONS

LUTS and OAB were prevalent conditions with significant bother and negative effects on quality of life among Polish adults aged ≥ 65 years. Nevertheless, most affected respondents had not sought treatment. Thus, for older persons, there is a need to increase public awareness about LUTS and OAB, and the negative effects of LUTS and OAB on healthy aging. In addition, greater government and healthcare system resources are needed to better manage LUTS and OAB in older patients.

Acute urinary retention in men: 21-year trends in incidence, subsequent benign prostatic hyperplasia-related treatment and mortality: A Danish population-based cohort study

OBJECTIVE

To examine trends in incidence of acute urinary retention, subsequent benign prostatic hyperplasia-related treatment and mortality in the era of medical therapy for benign prostatic hyperplasia. Additionally, to compare mortality with the general population.

MATERIALS AND METHODS

We conducted a Danish nationwide registry-based study including 70,775 men aged 45 years or older with a first hospitalization for acute urinary retention during 1997-2017. We computed annual standardized incidence rates, subsequent 1-year cumulative incidence of benign prostatic hyperplasia-related surgical and medical treatment, and standardized 3-month and 1-year mortality rates. Finally, we compared standardized all-cause and cause-specific mortality ratios with the general population.

RESULTS

The standardized incidence rate of acute urinary retention per 1000 person-years increased transiently from 2.34 to 3.42 during 1997-2004, but gradually declined to 2.95 in 2017. The 1-year cumulative incidence of benign prostatic hyperplasia-related surgery declined from 31.2% to 19.8% and 20.5% to 7.7% after spontaneous and precipitated acute urinary retention, respectively. During 1997-2017, the standardized 1-year mortality declined from 22.2% to 17.2%. Compared with the general population, mortality was 4-5 times higher after 3 months and 2-3 times higher after 1 year of acute urinary retention. The cause-specific standardized mortality ratios were particularly high for deaths attributable to malignancies, urogenital disease, certain infections, chronic pulmonary disease, and diabetes.

CONCLUSION

During 1997-2017, we observed a transient increase in the incidence of acute urinary retention. The subsequent use of benign prostatic hyperplasia-related surgery declined considerably and mortality continued to be high, mainly because of deaths from malignancies, urogenital disease, infections, and preexisting comorbidity.

Sex and Gender Differences in the Pharmacology of the Overactive Urinary Bladder

Dysfunction of the lower urinary tract in general and the overactive bladder syndrome (OAB) in particular are prevalent and have major impact on the quality of life of the afflicted patients and their partners. We concisely review sex and gender differences in patients and animal models in physiological bladder function, its alterations in disease (mostly OAB), and its responses to treatment. Women appear to have a smaller functional bladder capacity and, therefore, must void more often than men. On the other hand, men have a greater bladder outlet resistance, which is partly attributed to a longer urethra and partly to the presence of the prostate. Sex and gender differences in bladder contractility appear small and were not found consistently. The ability of bladder smooth muscle to relax may be somewhat smaller in females. However, females are heavily underrepresented in experimental studies on bladder function. Stress urinary incontinence is found predominantly in women (particularly those after childbirth). OAB is similarly prevalent in men and women. Females seek treatment much more often and are overrepresented in clinical trials. Treatment responses in OAB patients are similar in both genders for oral medications, but improvements upon injections of onabotulinum toxin type A appear smaller in men. We conclude that there is no evidence for major sex and gender differences in bladder dysfunction as related to OAB and its treatment responses, but female animals are heavily underrepresented in experimental studies.

A community-based study on lower urinary tract symptoms in Malaysian males aged 40 years and above

Lower urinary tract symptoms (LUTS) commonly affecting ageing men and is thought to be linked with other comorbidities and unhealthy lifestyles. This study was performed to report the prevalence of LUTS and its association with quality of life (QOL) in urination and other related factors. The study was part of the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional community-based survey in Malaysia. Validated self-administered bilingual International Prostate Symptom Score (IPSS) was used to assess the LUTS. Other comorbidities and unhealthy lifestyles were recorded using face-to-face interview and in-situ measurements such as anthropometry assessment and blood measurement. There were a total of 2251 respondents. 16.3% of the respondents had clinically significant LUTS (IPSS ≥ 8). LUTS was found to be significantly associated with QOL, age and inactive physical activities. Nocturia was the most prevalent and bothersome symptom. LUTS is a common condition and adversely affect QOL. Ageing and physically inactive males are associated with the development of LUTS. It is recommended to increase public awareness of the condition and availability of treatment options for LUTS. Any upcoming survey should have a more in-depth investigation such as clinical profiling of subjects.

Relationship between Lower Urinary Tract Symptoms and Treatment-Related Behavior in an Eastern European Country: Findings from the LUTS POLAND Study

Background: The aim of this study was to investigate the effect of lower urinary tract symptoms (LUTS) on behavior related to treatment of Polish adults aged ≥ 40 years. Methods: We conducted a computer-assisted telephone survey with a study sample stratified by age, sex, and place of residence (type, size, urban versus rural) reflecting the entire Polish population. Participants rated the frequency and symptom-specific bother of individual LUTS and their effects on seeking and receiving treatment, treatment satisfaction, and treatment continuation. We adjusted multiple logistic regression models to analyze the simultaneous effects of predictor variables on each dependent variable. Results: Overall, 6005 participants completed the interview. One third (29.6–33.5%) of participants with LUTS were seeking treatment, and 24.0–26.4% received treatment. There was no difference in treatment seeking and receiving between urban and rural areas. Whereas storage and voiding symptoms were significantly related to treatment seeking by both men and women, treatment receiving correlated only with voiding symptoms in men and only with storage symptoms in women. Most respondents who received treatment were satisfied; treatment dissatisfaction was related to the presence of storage symptoms in both men and women. Only 50% of all participants continued their treatment; discontinuation of treatment was statistically more prevalent for women than for men. Conclusion: This investigation, the first population-representative study performed in Eastern Europe, revealed a low frequency of seeking treatment for LUTS. In addition, symptoms that inclined participants to seek treatment might not have been adequately addressed by the treatment they received. We also found a relatively high rate of treatment discontinuation. Clearly, there is a need for both improved patient education about LUTS treatment and a need for increased clinician awareness of the coexistence of different symptoms in men and women plus proactive evaluation by physicians for all types of LUTS and associated bother.

Positive Predictive Value of Benign Prostatic Hyperplasia and Acute Urinary Retention in the Danish National Patient Registry: A Validation Study

Background and Aim

Benign prostatic hyperplasia comprises a significant burden to ageing men due to frequently associated lower urinary tract symptoms and the risk of developing serious complications, such as acute urinary retention. Healthcare databases are a valuable source of epidemiological research; however, continuous validation of definitions is imperative. We examined the positive predictive values of International Classification of Diseases, 10th Revision (ICD-10), diagnostic coding for benign prostatic hyperplasia and acute urinary retention in men in the Danish National Patient Registry.

Methods

We investigated a random sample of 100 men diagnosed with benign prostatic hyperplasia and 100 men diagnosed with acute urinary retention between 2011 and 2017 in the Central Denmark Region. Using medical record review as reference standard, we estimated the positive predictive value with corresponding 95% confidence intervals (CI) overall and stratified by age, type of hospital (university hospital vs regional hospital), type of hospital contact (inpatient, outpatient or emergency room), calendar year group (2011–2013, 2014–2017), and department (department of urology, geriatrics, endocrinology or emergency room).

Results

Medical records were available for all 200 sampled patients. We found an overall positive predictive value (PPV) of 95% (95% CI: 89–98%) for benign prostatic hyperplasia and 98% (95% CI: 93–99%) for acute urinary retention. The PPVs were consistent across age, type of hospital, type of hospital contact, calendar year group, and department.

Conclusion

The PPVs of ICD-10 codes for benign prostatic hyperplasia and acute urinary retention recorded in the Danish National Patient Registry are high.

Involvement of personal and professional relations among men bothered by lower urinary tract symptoms: a population-based cross-sectional study

Background

Lower urinary tract symptoms (LUTS) are common among men worldwide and despite frequently of benign origin, the symptoms often influence quality of life. Most men experiencing LUTS manage their symptoms in private settings without consulting their general practitioner (GP). Therefore, the purpose of this study was to identify who in the personal and professional relations Danish men discussed their bothersome LUTS with, to analyse factors associated with discussing LUTS with personal and professional relations, and to analyse how having a social network influenced healthcare seeking.

Methods

A nationwide population-based, cross-sectional survey representative of the Danish population. A total of 46,647 randomly selected men aged 20+ were invited to participate. Data were collected in 2012. The main outcome measures were odds ratios between involvement of personal and professional relations, GP contact and different characteristics (age, number of symptoms, available social network, and involvement of personal relations) among men experiencing bothersome LUTS. We used multivariate logistic regression models.

Results

Overall, 22,297 men completed the questionnaire. Of those, 4885 (21.9%) had experienced at least one LUTS, 23.5% had not discussed their symptoms with either personal nor professional relations and 59.1% had not discussed their LUTS with any professional relation. The symptoms were most often discussed with personal relations, primarily the spouse/partner who was involved in more than half of the cases. Odds of consulting the GP, another doctor and other healthcare professionals were two to four-fold higher when the symptoms were discussed with a personal relation. Having an available social network was significantly associated with lower odds of consulting the GP regarding frequent urination.

Conclusions

Despite the high prevalence of bothersome LUTS more than one-fifth of men did not discuss their symptoms with either personal nor professional relations, and more than half did not discuss the symptoms with any professional relations. Discussing the symptoms with personal relations was generally associated with higher odds of seeking professional help, and for frequent urination, having an available social network was associated with lower odds of consulting the GP. The results may be useful for detecting and treating men bothered by LUTS.

Lower Urinary Tract Symptoms: Prevalence and Factors Associated with Help-Seeking in Male Primary Care Attendees

Background

Lower urinary tract symptoms (LUTS) are common among elderly men. However, seeking help for this problem is mostly delayed until complications arise. Primary care clinics serve as the first point of contact for a person’s health needs throughout their life. This study aimed to determine the prevalence of LUTS among primary care attendees, and the factors that influence seeking medical intervention at primary care clinics.

Methods

Using a universal sampling technique, 460 male patients aged 60 and above visiting an urban based public primary care clinic were recruited. An interviewer administered the questionnaire which used International Prostate Symptoms Score and International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms-Quality of Life.

Results

The prevalence of any LUTS and clinically significant LUTS were 89.8% and 20.5%, respectively. Among the 385 participants who completed the study, only 41.8% had consulted a doctor for LUTS. Among those with moderate/severe symptoms only 57.6% had sought medical intervention. Multiple logistic regression analysis showed that the presence of more than two comorbidities (P=0.004; odds ratio [OR], 4.695; 95% confidence interval [CI], 1.632–13.508) and quality of life (P=0.002; OR, 1.271; 95% CI, 1.091–1.481) were independent factors significantly associated with seeking help.

Conclusion

Prevalence of LUTS among elderly men undergoing primary care is high, but more than half of the patients had not sought medical attention. Increasing comorbidities and impact on quality of life influenced elderly men with LUTS to seek help.

Patient Characteristics Associated with More Bother from Lower Urinary Tract Symptoms

PURPOSE

Some patients continue to have bothersome lower urinary tract symptoms despite treatment. We examined characteristics associated with bother from lower urinary tract symptoms in a prospective cohort.

MATERIALS AND METHODS

In this 1-year prospective, observational cohort study we obtained data on patients with lower urinary tract symptoms who were seeking care at a total of 6 tertiary care centers in the United States. Participants answered the AUA-SI (American Urological Association Symptom Index) global urinary bother question at study entry and 12 months later. Multilevel logistic and linear regression was used to identify factors associated with worsening bother and bother at 12 months, respectively.

RESULTS

Of the 756 participants 121 (16%) had worsened lower urinary tract symptom bother during the study period. When adjusted for other variables, worsened lower urinary tract symptom bother was more likely among men who were nonwhite (OR 1.79, 95% CI 0.94-3.40) or who had diabetes (OR 1.68, 95% CI 0.86-3.27) and among women with diabetes (OR 1.77, 95% CI 0.85-3.67), prior treatment of lower urinary tract symptoms (OR 2.58, 95% CI 1.22-5.46) or a higher depression level (OR 1.29, 95% CI 1.10-1.52). Baseline factors associated with more severe bother at 12 months in men included more severe bother at baseline, nonwhite race, worse urinary frequency and incontinence, and higher levels of stress (p <0.05). Among women more severe bother at baseline, urinary urgency and frequency, and worse physical function were associated with more severe bother at 12 months.

CONCLUSIONS

Urinary symptom severity at baseline, race, depression and psychological stress were associated with the bother of lower urinary tract symptoms in a prospective cohort of men and women treated at tertiary care facilities. These findings may inform the clinical care of patients with bothersome lower urinary tract symptoms and direct providers to better prognosticate for patients with challenging lower urinary tract symptoms cases.

Healthcare-seeking with bothersome lower urinary tract symptoms among men in the Danish population: the impact of lifestyle and socioeconomic status

Objective: (1) To identify possible factors of importance for reporting lower urinary tract symptoms (LUTS) among men and (2) to examine possible associations between socioeconomic status (SES), lifestyle factors, and likelihood of men contacting a general pracitioner (GP) regarding LUTS reported to be of concern or influencing daily activities (bothersome LUTS). Design: Nationwide population-based, cross-sectional survey. Data was collected in 2012. Setting: The general Danish population. Subjects: A total of 48,910 randomly selected men aged 20+. Main Outcome Measures: (1) Odds ratios for reporting LUTS by lifestyle and SES, and (2) Odds ratios for GP contact with bothersome LUTS by lifestyle and SES. Results: 23,240 men participated (49.8%). Nocturia was the most commonly experienced LUTS (49.8%). Incontinence was most often reported as bothersome (64.1%) and nocturia less often reported as bothersome (34.2%). Only about one third of the men reporting a bothersome LUTS contacted their GP. Odds for reporting LUTS significantly increased with increasing age, obesity, and lack of labor market affiliation. Increasing age and symptom burden significantly increased the odds for GP contact regarding bothersome LUTS. No overall associations were found between lifestyle, SES, and GP contact. Conclusion: Bothersome LUTS are common among Danish men. Concern and influence of LUTS on daily activities are important determinants of GP contact, yet only one in three bothersome LUTS are discussed with a GP. Advanced age and symptom burden were significantly associated with GP contact. Implications: Information on treatment options for LUTS might be desirable among Danish men regardless of SES and lifestyle. Key points Urological symptoms are common among men in the Danish population and are often managed without contacting healthcare professionals. Increasing age and symptom burden significantly increase the likelihood of consulting a general practitioner regarding bothersome urological symptoms Healthcare-seeking behavior with bothersome urological symptoms is not influenced by lifestyle or socioeconomic status among Danish men; Information about available, effective treatment options for urological symptoms might be desirable among men regardless of socioeconomic status and lifestyle.

Impact of LUTS on treatment-related behaviors and quality of life: A population-based study in Brazil

AIMS

To report on the impact of lower urinary tract symptoms (LUTS) on treatment-related behaviors and quality of life in Brazilian adults greater than or equal to 40 years.

METHODS

Data were from a computer-assisted telephone survey conducted in Brazil between 1 September and 31 December 2015 (Brazil LUTS study). Participants were adults greater than or equal to 40 years with landlines living in major cities from five geographical regions in Brazil. Participants rated how often they experienced individual LUTS during the previous month and associated bother, and the impact on quality of life (QoL), treatment seeking, treatment, treatment satisfaction, and treatment discontinuation. Multiple logistic regression models were adjusted to analyze the simultaneous effects of predictor variables on each dependent variable.

RESULTS

When the presence of LUTS was defined as symptoms occurring less than half the time or more, one-quarter of respondents sought treatment but 6% fewer actually received treatment. Of these, around 25% reported dissatisfaction with treatment and almost 10% reported treatment discontinuation. The occurrence of some symptoms and, in particular, the resultant bother were significantly related to worse QoL and to treatment-related outcomes, such as treatment seeking, actual treatment, treatment dissatisfaction, and treatment discontinuation. Symptoms of all three categories were associated with all these domains for both sexes.

CONCLUSIONS

This is the first population-based study carried out in South America showing that treatment seeking and treatment rates for LUTS are low. Since the LUTS prevalence is high, this reinforces the importance of a comprehensive medical assessment, focusing on the resulting bother, for more appropriate and personalized patient management.

Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature

We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.

Urological symptoms among 23,240 men in the general danish population - concerns about symptoms, their persistence and influence on primary care contacts

OBJECTIVE

To analyse possible associations between men's likelihood of contacting a general practitioner (GP) for urological symptoms and the persistence of the symptoms, the influence on daily activities and the level of concern about the symptoms.

DESIGN

Web-based nationwide cross-sectional questionnaire study.

SETTING

The general population in Denmark.

SUBJECTS

48,910 randomly selected men aged 20+ years.

MAIN OUTCOME MEASURES

Urological symptom prevalence and odds ratios for GP contact with urological symptoms in regard to concern for the symptom, influence on daily activities and the persistence of the symptom.

RESULTS

Some 23,240 men responded to the questionnaire, yielding a response rate of 49.8%. The prevalence of at least one urological symptom was 59.9%. Among men experiencing at least one urological symptom almost one-fourth reported contact to general practice regarding the symptom. Approximately half of the symptoms reported to be extremely concerning were discussed with a GP.

CONCLUSION

Increased symptom concern, influence on daily activities and long-term persistence increased the likelihood of contacting a GP with urological symptoms. This research points out that guidelines for PSA testing might be challenged by the high prevalence of urological symptoms. Key points  The decision process of whether to contact the general practitioner (GP) is influenced by different factors, but contradictory results has been found in triggers and barriers for help-seeking with urological symptoms.   • Increased symptom concern, influence on daily activities and long-term persistence consistently increased the likelihood of contacting a general practitioner with urological symptoms in men.   • Only 50% of the symptoms reported to be extremely concerning were however discussed with the GP.   • Guidelines for PSA testing might be challenged by the high prevalence of urological symptoms.

Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study

Background

Lower urinary tract symptoms (LUTS) and overactive bladder (OAB) symptoms have a substantial effect on quality of life (QoL). We report QoL and mental health results from a LUTS prevalence study in three Asian countries.

Methods

A cross-sectional, population-representative, internet-based study among individuals aged ≥40 years in China, Taiwan and South Korea. Instruments included: Overactive Bladder Symptom Score (OABSS); International Prostate Symptom Score (IPSS); other International Continence Society (ICS) symptom questions; health-related QoL 12-item short-form (HRQoL-SF12v2); Work Limitations Questionnaire (WLQ); Hospital Anxiety and Depression Scale (HADS). Presence of LUTS was determined according to ICS criteria, with three symptom groups (storage, voiding and post-micturition). Post-stratification weighting matched the age and sex population distribution per country. Initial data analyses were based on descriptive statistics. Significance testing undertaken post hoc included: independent-samples t-test (differences in HRQoL between sexes and between individuals with/without LUTS; relationship between HRQoL score and OABSS; differences in HADS anxiety and depression scores between individuals with/without LUTS; association between HADS anxiety/depression scores and OABSS), chi-square test (association between LUTS prevalence and workplace productivity) and analysis of variance (differences in HRQoL score and in HADS anxiety/depression scores between individuals with different symptom groups, association between HADS anxiety/depression scores and IPSS).

Results

In total, 8284 participants were included. HRQoL scores were significantly worse (p < 0.001) among individuals with versus without LUTS (ICS criteria): mean physical health domain scores were 61.1 (standard deviation [SD], 20.1) and 76.7 (17.0), respectively; corresponding mental health domain scores were 34.8 (12.7) and 43.7 (10.7). Workplace productivity was best among individuals without LUTS (difficulties reported by 2–3% of individuals), and worst in those with all three ICS symptom groups (difficulties reported by 29–38% of individuals; p = 0.001). Mean HADS scores showed significantly worse (p < 0.001) levels of anxiety and depression among individuals with versus without LUTS: anxiety, 6.5 (SD, 3.7) and 4.0 (3.3); corresponding mean depression scores were 6.8 (4.3) and 4.2 (3.6). Increasing OAB severity was also associated with decreasing HRQoL physical and mental health scores.

Conclusion

LUTS and increasing OAB severity are both associated with impaired QoL, reduced workplace productivity, and increased tendency towards anxiety and depression. These results highlight the need to ensure that individuals with LUTS receive appropriate, effective treatment.

Trial registration

ClinicalTrials.gov identifier: NCT02618421, registered 26 November 2015 (retrospectively registered).

The prevalence of lower urinary tract symptoms (LUTS) in Brazil: Results from the epidemiology of LUTS (Brazil LUTS) study

AIMS

We performed the first large population-based study to evaluate lower urinary tract symptoms (LUTS) in Brazil. The study objective was to assess the prevalence and bother of LUTS in the population aged ≥40 years in five major cities of Brazil.

METHODS

This study was conducted as a telephone survey with assessment of LUTS using a standardized protocol, which included the International Prostate Symptom Score (IPSS) and, for overactive bladder (OAB), the OAB-V8 questionnaire. Participants were asked to rate how often they experienced individual LUTS and the degree of associated bother.

RESULTS

Of the 5184 participants, 53% were women, and the age group with most participants (34%) was 50-59 years. The prevalence of LUTS (symptoms occurring less than half the time or more) was 75%: 69% in men and 82% in women. There was a statistically significant association between the frequency and bother intensity of each symptom (P < 0.001). The prevalence of OAB was similar in men and women (25% and 24%, respectively). According to the IPSS questionnaire, moderate-to-severe symptoms were present in 21% of men and 24% of women. LUTS detrimentally affected quality of life in many individuals: 39% would be "mostly dissatisfied," "unhappy," or consider it "terrible" to spend the rest of their life with their urinary condition as it is currently.

CONCLUSIONS

This was the first nationwide, population-based epidemiological study of LUTS to be performed in Brazil. LUTS are highly prevalent and often bothersome among men and women aged ≥40 years.

Toileting behavior and urinary tract symptoms among younger women

Introduction and hypothesis

Irregular or infrequent voiding due to avoiding school toilets can contribute to a number of urinary problems among school children. There is, however, a lack of studies on younger women. The aim of this study was to investigate toileting behavior and the correlation to lower urinary tract symptoms (LUTS) among young women (age 18–25 years). A further aim was to validate the Swedish version of the Toileting Behavior scale (TB scale).

Methods

Quantitative descriptive design was used with two questionnaires: the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and the TB scale, together with six background questions. The questionnaires were distributed in November 2014 to 550 women aged 18–25 years randomly selected from the population register in southern Sweden.

Results

A total of 173 (33%) women responded. Mean age was 21.6 years (range 18–25). The Swedish version of TB scale showed good construct validity and reliability, similar to the original. Most toileting behavior was significantly correlated with LUTS, which were common, as 34.2% reported urgency and 35.9% urine leakage at least sometimes or more often.

Conclusions

LUTS were quite common in this group of young women. Toileting behaviors were also significantly related to urinary tract symptoms. Thus, TB scale was useful in this population, and the translated Swedish version showed good construct validity and reliability.

Treatment strategy for urinary frequency in women

The purpose of this paper is to discuss the differential diagnosis of the underlying etiologies of urinary frequency and the treatment strategies for urinary frequency in women. Urinary frequency is a symptom, a sign, and a condition of uncertainty and of multifactorial cause. Common causes of urinary frequency include psychosocial, medical, sexual, urological, gynecologic, endocrine, and pharmacological in origin. Hence, treatment of symptoms and possible cures need a high-level plan or strategy to overcome the multifactorial etiology. Proper investigation of the chief complaint, history and physical examinations, is needed to evaluate urinary frequency. Pregnancy test, wet smear, urinalysis, midstream urine culture, frequency-volume charts, cystourethroscopy, urodynamics, and genitourinary imaging are the basic routine of office investigations. These tools promote the accuracy of the differential diagnosis of the underlying cause of urinary frequency. It is then often helpful to adopt an algorithmic approach to the management of this complaint. Treatment of urinary frequency might be empirical, and it remains a clinical challenge to gynecologists. To cure the disease, it is important to listen to the patient and consider the condition in all its aspects and use proven techniques.

Apoptotic Pathways Linked to Endocrine System as Potential Therapeutic Targets for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a chronic condition common in older men that can result in bothersome lower urinary tract symptoms. The molecular mechanisms and networks underlying the development and the progression of the disease are still far from being fully understood. BPH results from smooth muscle cell and epithelial cell proliferation, primarily within the transition zone of the prostate. Apoptosis and inflammation play important roles in the control of cell growth and in the maintenance of tissue homeostasis. Disturbances in molecular mechanisms of apoptosis machinery have been linked to BPH. Increased levels of the glycoprotein Dickkopf-related protein 3 in BPH cause an inhibition of the apoptosis machinery through a reduction in B cell lymphoma (Bcl)-2 associated X protein (Bax) expression. Inhibitors of apoptosis proteins influence cell death by direct inhibition of caspases and modulation of the transcription factor nuclear factor-κB. Current pharmacotherapy targets either the static component of BPH, including finasteride and dutasteride, or the dynamic component of BPH, including α-adrenoceptor antagonists such as tamsulosin and alfuzosin. Both these classes of drugs significantly interfere with the apoptosis machinery. Furthermore, phytotherapic supplements and new drugs may also modulate several molecular steps of apoptosis.

Prevalence and Progression of Lower Urinary Tract Symptoms in an Aging Population

OBJECTIVE

To examine the prevalence of lower urinary tract symptoms (LUTS) in males of the general population.

MATERIALS AND METHODS

In our analysis, we included 8627 men, 48-79 years of age, who participated in the fourth follow-up (FUP) of EPIC-Heidelberg (2007-2009) and replied to questions on LUTS. According to the International Prostate Symptom Score questionnaire, men were categorized as having mild (0-7 points), moderate (8-19 points), or severe LUTS (20-35 points). In addition, we examined progression of LUTS among 7821 men, who also participated in FUP 5 (2010-2012).

RESULTS

There were 75.3% of men who reported mild, 22.0% who reported moderate, and 2.7% who reported severe LUTS. The prevalence increased with age. At FUP 4, 5.8% (mild symptoms) to 39.7% (severe LUTS) of participants reported use of any type of benign prostatic hyperplasia or LUTS medication. Nocturia, that is, getting up at night at least twice, was the most common symptom, followed by incomplete emptying of the bladder and urgency. There were 54.8% of men who reported worse LUTS in FUP 5, but 27.1% reported an improvement in symptoms.

CONCLUSION

About a quarter of middle-aged and elderly men reported clinically relevant LUTS. Whereas symptoms in some men actually improve, more than half of men experience worsening of symptoms over a 3-year period in time.

Nocturia, Insomnia Symptoms and Mortality among Older Men: The Health, Aging and Body Composition Study

STUDY OBJECTIVES

To examine the association between nocturia (walking up from sleep for urination) and mortality risk among community dwelling older men.

METHODS

This is a secondary data analysis using data obtained from the Health Aging Body Composition (Health ABC) study. Frequency of nocturia was determined at baseline using a questionnaire.

RESULTS

A total of 1,478 older men, mean (SD) age 73.8 (2.9) years, were included in the analysis. During a follow up period of 9.9 years, a total of 760 deaths were reported. Mortality rate was significantly higher for participants with 3 or more nocturia episodes per night, in comparison to those with 0-1 episodes (HR [CI] : 1.21 [1.00-1.47], p = 0.055), even after controlling for baseline characteristics which included demographic variables, body mass index, lower urinary tract symptoms, use of loop diuretics, insomnia symptoms, feeling excessively sleepy during the day/daytime naps, sleep duration, and use of sleep medications. However, the association between ≥ 3 nocturia episodes per night and mortality risk was no longer statistically significant once prevalent diabetes mellitus and cardiovascular disease were included in the model (HR [CI]: 1.18 [0.97- 1.44], p = 0.100).

CONCLUSIONS

Nocturia is associated with mortality independent of insomnia symptoms and sleep duration. The relationship is explained in part by prevalent cardiovascular disease and diabetes mellitus. The results underscore the impact of these medical conditions on the association between 3 or more nocturia episodes and increased mortality risk among older men.

Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome

Epidemiological studies have shown that age is the principal unmodifiable risk factor of lower urinary tract symptoms (LUTS). Until the past decade, the process of lower urinary tract ageing was, therefore, considered unmodifiable - as ageing per se. However, the traditional dogma that BPH-related LUTS (BPH-LUTS) is an immutable consequence of old age is no longer acceptable. Results from multiple preclinical and clinical studies indicate that several modifiable, age-related metabolic aberrations (metabolic syndrome, obesity, dyslipidaemia, diabetes) are important determinants in both the development and the progression of BPH-LUTS. Metabolic syndrome and its related comorbidities, such as sex steroid alterations and low-grade inflammation, have been related to BPH-LUTS development and progression. With the correct treatment and recommended lifestyle changes, many individuals with metabolic syndrome might be able to prevent or delay the onset of metabolic-syndrome-related complications; however, whether promoting healthier lifestyles can really alter a man's propensity to develop BPH-LUTS remains to be clarified.

Clinical Guideline for Female Lower Urinary Tract Symptoms

The "Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms," published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post-voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re-evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post-voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.

Why do men suffering from LUTS seek primary medical care? A qualitative study

RATIONALE, AIMS AND OBJECTIVES

Lower urinary tract symptoms (LUTS) are common problems among men, but only a small proportion actually visit their general practitioner (GP). This study aims to gain insight into the reasons why men visit a doctor, and their expectations.

METHODS

We opted to perform a qualitative study with semi-structured interviews among men aged over 50 years who consulted their GP because of suffering from LUTS. All interviews were fully transcribed and coded and analysed by two researchers using ATLAS.ti.

RESULTS

We interviewed 18 men between the ages of 52 and 80. Frequently mentioned reasons for seeking help can be grouped under three main themes: a wish for reassurance about not having prostate cancer, the nuisance of symptoms such as nycturia and being triggered by public information about LUTS. Most participants lacked an understanding of the cause and prognosis of their symptoms.

CONCLUSION

The main reasons to seek primary medical care are the need for reassurance and the nuisance of symptoms, especially nycturia. Overall, the patients show remarkably poor knowledge about their symptoms.

Lower urinary tract symptoms among Caucasian-European men who have sex with men: findings from a real-life survey

BACKGROUND

Prevalence of and severity of lower urinary tract symptoms (LUTS) according to male sexual orientation have been scantly analysed. We aimed to assess the prevalence and severity of LUTS in a cohort of Caucasian-European men who have sex with men seeking medical help for uroandrologic reasons other than LUTS.

METHODS

Data from 949 consecutive individuals in an outpatient setting were analysed. Severity of LUTS was measured with the International Prostate Symptom Score (IPSS). Men with storage symptoms scored 1-3 and ⩾ 4 (of 15), and voiding symptoms scored 1-4 and ⩾ 5 (of 20) were considered as having mild and moderate-to-severe symptoms, respectively. For individual symptoms, patients with scores ⩾ 1 were deemed symptomatic (according to Apostolidis et al.(15)). Descriptive statistics and logistic regression models tested the association between LUTS and sexual orientation.

RESULTS

Complete data were available for 213 (22.4%) men who have sex with men (MSM) and 736 (77.6%) heterosexuals (mean age (s.d.): 41.0 (12.2) vs 39.9 (12.1) years). Compared with heterosexuals, MSM reported higher rates of total IPSS scores suggestive of moderate (21.6% vs 20%) and severe LUTS (3.8% vs 2.4%) (P=0.004). Similarly, MSM showed higher rates of mild (48.8% vs 45.2%) and moderate-to-severe (39.4% vs 30.4%) storage symptoms (all P<0.001), and of mild (45.1% vs 34.8%) and moderate-to-severe (20.2% vs 19.2%) voiding symptoms (all P<0.01). MSM status was an independent predictor of mild voiding symptoms (odds ratio (OR): 1.40; P=0.004), moderate-to-severe storage symptoms (OR: 1.40; P=0.04) and severe total IPSS (OR: 1.49; P=0.03), after adjusting for other variables.

CONCLUSIONS

These findings suggest a higher prevalence and severity of LUTS in MSM compared with heterosexual men seeking medical help for uroandrologic reasons other than LUTS.

A Population-based Survey of the Prevalence, Potential Risk Factors, and Symptom-specific Bother of Lower Urinary Tract Symptoms in Adult Chinese Women

BACKGROUND

Epidemiological studies of lower urinary tract symptoms (LUTS) are few in China, and none has been conducted nationwide.

OBJECTIVE

To estimate the prevalence and potential risk factors of LUTS and the bother they impose on adult women in China.

DESIGN, SETTING, AND PARTICIPANTS

This is the second analysis of a population-based cross-sectional survey on urinary incontinence conducted between February and July 2006 in six regions of China. Cluster samples were randomly selected for interviews.

INTERVENTIONS

No intervention was implemented.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

A modified Chinese Bristol Female Lower Urinary Tract Symptoms questionnaire was administered. The participants were asked about the presence of individual LUTS and rated their symptom bother. Descriptive statistics, χ(2) tests, receiver operating characteristic curves, and multivariate logistic regressions were used for data analysis.

RESULTS AND LIMITATIONS

A total of 18 992 respondents (94.96%) were included. The prevalence of any LUTS, storage symptoms, or voiding symptoms was 55.5%, 53.9%, and 12.9%, respectively, and increased with age. Nocturia was the most common symptom (23.4%), followed by urgency (23.3%) and stress urinary incontinence (SUI; 18.9%). Nocturia was most frequently rated as bothersome (93.0%) but was generally minor (80.5%). Urgency and urgency urinary incontinence (UUI) were most frequently reported as severe (11.5% and 10.8%) or moderate (18.5% and 16.8%) bothers. Any LUTS were more prevalent in urban women (57.1% vs 53.9%). Multiple factors increased the odds of bother and individual LUTS, and older age and coexisting pelvic organ prolapse were strong predictors (p<0.05). This survey was conducted 8 yr ago and did not assess all LUTS.

CONCLUSIONS

Half of adult women suffered with LUTS; nocturia, urgency, and SUI were more prevalent. Urgency and UUI were most frequently reported as severe or moderate bothers. Multiple factors influenced bother and individual LUTS.

PATIENT SUMMARY

The prevalence of lower urinary tract symptoms is high and increases with age in adult women in China. Urgency and urgency urinary incontinence were most frequently regarded as severe or moderate bothers and should be targeted for medical intervention.

Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK

KEY MESSAGES

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45-49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.

Prevalence, associated factors, and relationship to quality of life of lower urinary tract symptoms: a cross-sectional, questionnaire survey of cancer patients

BACKGROUND

Few studies conducted outside of Asia have shown that lower urinary tract symptoms (LUTS) could be a concern for cancer patients. This gap necessitates more research on LUTS among cancer patients in Asia, particularly regarding associated factors and the relationship between quality of life and LUTS.

OBJECTIVES

This study investigates the prevalence, associated factors, and relationship to quality of life of LUTS based on a sample of cancer patients.

DESIGN

A cross-sectional, questionnaire survey.

SETTINGS/PARTICIPANTS

This study was conducted at two oncology outpatient departments in two hospitals in Taiwan, and included 134 Asian cancer patients.

METHODS

We collected information about each participant's individual characteristics, personal habits, LUTS, and quality of life by using a questionnaire. We calculated descriptive statistics to demonstrate the distribution of collected information, and used multivariate logistic regression to identify the factors associated with LUTS. We used Student's t-test to compare the mean quality of life scores for participants with and without LUTS.

RESULTS

Ninety-nine (73.9%) participants experienced at least one type of LUTS, and the prevalence rates for various types of LUTS ranged from 3.7% to 52.2%. Radiotherapy and the time since the diagnosis of cancer were associated with LUTS. Participants with LUTS reported lower quality of life scores than participants without LUTS.

CONCLUSIONS

The high prevalence of LUTS suggests that cancer treatment might be linked to LUTS, which in turn has a negative effect on a patient's quality of life. These results suggest that future research should involve studies in larger, more homogeneous samples. Health care providers should monitor the presence of LUTS and deliver the management and treatments of LUTS to optimise cancer patients' quality of life.

Lower urinary tract symptoms and falls risk among older women receiving home support: a prospective cohort study

Background

Although lower urinary tract symptoms have been associated with falls, few studies have been undertaken to understand this relationship in vulnerable community dwelling older adults. The purpose of this study was to describe the relationship over time of falls risk and lower urinary tract symptoms among community based older women receiving home support services.

Methods

A prospective cohort study which took place in an urban setting in western Canada. Participants were 100 older women receiving home care or residing in assisted living with home support services and were followed for six months. Demographic characteristics were collected at baseline, with the Timed Up and Go (TUG), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), and self-report of falls collected at baseline, 3 and 6 months. Descriptive statistics were used to summarize demographic data. Differences between the three visits were analyzed using the Friedman test with post hoc analysis and associations between variables by the Spearman Rank-Order Correlation Coefficient.

Results

One hundred women initially enrolled; 88 and 75 remained at three months and six months. Mean age = 84.3 years; 91% reported at least one urinary symptom at baseline and 35% reported falling in the six months prior to enrollment; 15.9% reported falling between the baseline and three months and 14.6% between three and six months. Mean TUG scores at each time point indicated falls risk (27.21, 29.18 and 27.76 seconds). Significant correlations between TUG and ICIQ-FLUTS (r ₌ 0.33, p < .001; r ₌ 0.39, p < .001) as well as TUG and overactive bladder scores (r ₌ 0.25, p = .005; r ₌ 0.28, p < .008) were found at baseline and three months, but not six months.

Conclusions

The association of lower urinary tract symptoms and falls risk in this group of vulnerable community dwelling older women at baseline and three months has potential clinical relevance. Lack of correlation at six months may be due loss of less robust participants, illuminating the difficulty in following frailer groups over time. Further studies are needed to understand the contribution of urinary symptoms to falls risk, and clinicians should incorporate continence assessment within falls risk assessment.

In a free healthcare system, why do men not consult for lower urinary tract symptoms (LUTS)?

BACKGROUND

The prevalence of lower urinary tract symptoms (LUTS) varies among different populations but the rate of seeking medical advice is consistently low. Little is known about the reasons for this low rate. In the city of Macau, China, primary healthcare is free and easily accessible to all citizens. We aim to study the patients' rate of consulting for LUTS and their reasons for not consulting under a free healthcare system.

METHOD

A convenience sample of 549 male patients aged 40-85 years in a government health centre filled in the International Prostate Symptoms Scale (IPSS) questionnaire. They were also asked if they had consulted doctors for LUTS, and if not, why not.

RESULT

Of the whole sample, 64 men (11.7%) had ever consulted doctors for LUTS. Of 145 with moderate to severe LUTS, 35 (24.1%) consulted. Of 73 who were dissatisfied with their quality of life, 22 (30.1%) consulted. Regarding the symptoms as normal or not problematic was the main reason for not consulting. Advancing age and duration of symptoms were the significant factors for consulting.

CONCLUSION

Primary care doctors could help many of LUTS patients by sensitively initiating the discussion when these patients consult for other problems.

Validity of the Danish Prostate Symptom Score questionnaire in stroke

OBJECTIVE

To determine the content and face validity of the Danish Prostate Symptom Score (DAN-PSS-1) questionnaire in stroke patients.

MATERIALS AND METHODS

Content validity was judged among an expert panel in neuro-urology. The judgement was measured by the content validity index (CVI). Face validity was indicated in a clinical sample of 482 stroke patients in a hospital-based, cross-sectional survey.

RESULTS

I-CVI was rated >0.78 (range 0.94-1.00) for 75% of symptom and bother items corresponding to adequate content validity. The expert panel rated the entire DAN-PSS-1 questionnaire highly relevant (S-CVI = 1.00). No experts suggested items omitted or improved. The response rate was 84% and face validity had an acceptable level of completed response for each symptom items (96-98%) and bother items (93-96%) indicating that all items were well interpreted.

CONCLUSION

The DAN-PSS-1 questionnaire appears to be content and face valid for measuring lower urinary tract symptoms after stroke.

Gender and age differences in the perception of bother and health care seeking for lower urinary tract symptoms: results from the hospitalised and outpatients' profile and expectations study

BACKGROUND

Few comparisons have been made of health care seeking behaviour for lower urinary tract symptoms (LUTS) between men and women, as well as trends across age groups.

OBJECTIVE

To investigate the bother from LUTS and effect on health care seeking in both men and women of different age groups and in comparison between the two genders.

DESIGN, SETTING, AND PARTICIPANTS

A representative cross section of each of 13 clinics of a general academic hospital, with equal numbers of subjects recruited in each of six design cells that were defined by age (18-40, 41-60, 61-80 yr) and gender.

INTERVENTION

A 2-h in-person interview, conducted by a trained psychologist/interviewer in a clinic office.

MEASUREMENTS

Severity of LUTS was measured by the International Prostate Symptom Score (IPSS). Treatment seeking was measured by a single item. A bother question was modified to assess overall bother. Impact on quality of life (QoL) was measured by the IPSS QoL question.

RESULTS AND LIMITATIONS

The final study sample comprised 415 patients. More women than men reported the presence of LUTS (85.5% vs 75.2%; p=0.01). LUTS were more bothersome in women (25.4% of women vs 17.6% of men with bother "some" or "a lot"; p=0.02). Severity of LUTS increased with age in both genders (men: p<0.001; women: p=0.03). Bother from LUTS increased as severity of symptoms increased in both genders (p<0.001) but was associated with age only in men (p<0.001). QoL showed similar results as bother. Although men and women had equal prevalence of treatment seeking (27.9% vs 23.7%; p=0.40), men, but not women, were more likely to seek treatment as age (p<0.01) and severity of LUTS (p<0.001) increased. In multivariate logistic regressions, only bother from LUTS was associated with treatment seeking in women, compared with bother, age, and the presence of voiding symptoms in men.

CONCLUSIONS

In our hospital-based sample, differences in LUTS frequency, bother, and health care seeking profiles between men and women suggest a different perception and response to LUTS between the two genders.

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.