The prevalence of lower urinary tract symptoms in Austrian males and associations with sociodemographic variables

Multiple sclerosis and lower urinary tract symptoms: A survey of prevalence, characteristic and urological evaluations

Objective

Most multiple sclerosis patients have urological complications such as lower urinary tract symptoms. This study was conducted to evaluate the prevalence of these symptoms and whether they result in a urological evaluation.

Methods

A cross-sectional study of 517 multiple sclerosis patients at Tehran's referral multiple sclerosis center and neurology clinics between 2018 and 2022 was performed. Data were collected through interviews after patients completed informed consent forms. Urological examinations, including urine analysis and ultrasonography, were evaluated as final assessments. The data were analyzed using descriptive and inferential statistical tests in Statistical Package for Social Science.

Results

Among all participants, the prevalence of lower urinary tract symptoms was 73% (n = 384), with urgency (44.8% n = 232) being the most common symptom. The prevalence of intermittency was significantly higher among women (p = 0.004). There was no gender-significant difference in terms of the prevalence of other symptoms (p > 0.050). Lower urinary tract symptoms were significantly correlated with age, clinical course, disease duration, and disability (p < 0.001). Additionally, 37.3% and 18.7% of patients with lower urinary tract symptoms, as well as 17.9% and 37.5% of patients with multiple sclerosis attacks, respectively, had undergone urine analysis and ultrasonography.

Conclusion

Multiple sclerosis patients rarely undergo urological evaluations during the course of their disease. Proper assessment is essential as these symptoms are among the most detrimental manifestations of this disease.

Integrated Item Response Theory Modeling of Multiple Patient-Reported Outcomes Assessing Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

In clinical trials within lower urinary tract symptoms due to benign prostatic hyperplasia (BPH-LUTS), the International Prostate Symptom Score (IPSS) is commonly the primary efficacy outcome while the Quality of Life (QoL) score and the BPH Impact Index (BII) are common secondary efficacy markers. The current study aimed to characterize BPH-LUTS progression using responses to the IPSS, the QoL, and the BII in an integrated item response theory (IRT) framework and assess the Fisher information of each scale. The power of this approach to detect a drug effect was compared with an IRT approach considering only IPSS responses. A unidimensional and a bidimensional pharmacometric IRT model, based on item-level IPSS responses in a clinical trial with 403 patients, were extended by incorporating patients’ QoL and summary BII scores over the 6-month trial period. In the developed unidimensional integrated model, the QoL score was found to be the most informative, representing 17% of the total Fisher information, while the combined information content of the seven IPSS items represented 70.6%. In the bidimensional model, “storage” and both storage and “voiding” disability drove QoL and summary BII responses, respectively. Sample size reduction of 16% to detect a drug effect at 80% power was obtained with the unidimensional integrated IRT model compared with its counterpart IPSS IRT model. This study shows that utilizing the information content across the IPSS, QoL, and BII scales in an integrated IRT framework results in a modest but meaningful increase in power to detect a drug effect.

Quality of life among patients with multiple sclerosis and voiding dysfunction: a cross-sectional study

BACKGROUND

Evaluating the usefulness of treatment requires a direct measurement of the health-related quality of life (QOL). Therefore, this study was carried out aiming to determine the QOL of patients with MS and voiding dysfunction.

METHODS

This cross-sectional study was carried out using multi-stage random cluster sampling method on 602 patients with MS in Isfahan, Iran. All data were collected through interviews using standard questionnaires including International Prostate Symptom Score (IPSS), and the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Data were analyzed using descriptive and inferential statistical tests.

RESULTS

The prevalence rate of mixed, irritative, and obstructive urinary symptoms was 52.2, 25.5, and 6.5%, respectively. The mixed symptom had the highest prevalence among men and women with rates of 56.5 and 51.1%, respectively. The prevalence of irritative and obstructive symptoms was, respectively, higher and statistically significant among women alone and men alone (P <  0.05). The prevalence of irritative symptoms was higher among patients with MS, EDSS score ≤ 3, disease duration of less than 5 years, and with clinically isolated syndrome. In addition, the prevalence of mixed symptoms was higher among patients with MS of over 30 years of age with a Pre-high school degree, severe disability, disease duration of over 10 years, and progressive MS; the difference was statistically significant (P <  0.05). There was a difference in the combined dimensions of physical and mental health of QOL between the two groups with and without urinary symptoms (P <  0.05). Logistic regression analysis revealed that there was a higher probability of a urinary problems among patients with MS and high age [3.273 (1.083-9.860); P = 0.035].

CONCLUSIONS

Mixed urinary symptoms are highly prevalent among MS patients and affect QOL dimensions. In order to improve QOL, more attention and focus should be paid to urinary problems in MS patients.

Age-related histological and zinc content changes in adult nonhyperplastic prostate glands

To clarify age-related histological and Zn content changes in nonhyperplastic adult prostate glands, a quantitative morphometric and energy-dispersive X-ray fluorescence analyses were performed. The prostates were obtained from autopsies of 63 subjects aged 21-70 years who died mainly from trauma. It was found that histologically normal prostate tissue undergoes substantial changes throughout aging. These changes are reflected in an increase of the percent volume of the glandular lumen for the third to fifth decades, reaching a maximum for the decade 41-50 years. Over the same period, the percent volume of the stroma remains steady, but the percent volume of epithelium decreases, approximately, linearly with age. The percent volume of glandular lumen (reflects the volume of prostatic fluid) in the prostate gland of men aged 41 to 50 years is 1.5-fold higher than that in men aged 21 to 30 years, but the epithelium/lumen (prostatic fluid) ratio is approximately twofold lower. This suggests that accumulation of the prostatic fluid develops from 30 to 50 years of age. This accumulation of the prostatic fluid results in an increase of the Zn mass fraction in the prostate. In turn, when the intraprostatic Zn level exceeds a certain level by the end of the fifth decade, it begins to work as a trigger for different factors, all of which increase the proliferation of stromal cells. Deductions from these results allow possible partial explanations of both relevant prostatic aging mechanisms and the effects of dietary interventions using supplementary Zn.

Impact of behaviour and lifestyle on bladder health

Bladder conditions, including UTI, UI, and bladder cancer, are highly prevalent and affect a wide range of populations. There are a variety of modifiable behavioral and lifestyle factors that influence bladder health. Some factors, such as smoking and obesity, increase the risk or severity of bladder conditions, whereas other factors, such as pelvic floor muscle exercise, are protective. Although clinical practice may be assumed to be the most appropriate ground for education on behavioral and lifestyle factors that influence bladder health, it is also crucial to extend these messages into the general population through public health interventions to reach those who have not yet developed bladder conditions and to maximize the prevention impact of these behaviors. Appropriate changes in these factors have the potential for an enormous impact on bladder health if implemented on a population-based level.

Increased high-sensitivity C-reactive protein predicts a high risk of lower urinary tract symptoms in Chinese male: Results from the Fangchenggang Area Male Health and Examination Survey

BACKGROUND

Reports have shown that increased serum C-reactive protein (CRP) suggests a risk of lower urinary tract symptoms (LUTS) in the West population. However, few studies have investigated the role of CRP as regards LUTS in a Chinese male population.

METHODS

Data were collected from 1,452 men who participated in the population-based Fangchenggang Area Male Health and Examination Survey (FAMHES), which was carried out in Guangxi, China, from September 2009 to December 2009. In the current study, serum CRP was measured with a high-sensitivity method (hsCRP) and LUTS was assessed by International Prostate Symptom Score (IPSS). Meanwhile, information about potential confounding variables (smoking, hypertension, diabetes, etc.) were included.

RESULTS

We observed that statistically significant distinction presented in the distribution of hsCRP levels and age between LUTS group and non-LUTS group (P < 0.001). Comparing with the lowest hsCRP tertile, men with the highest hsCRP tertile were 1.72 times more likely to have overall LUTS and 1.93 times more likely to have irritative symptoms. As for individual symptoms of LUTS, statistically significant correlations were noted between serum hsCRP levels and urgency (OR = 1.74, 95% CI = 1.09-2.78) and nocturia (OR = 1.64, 95% CI = 1.18-2.27), when comparing them from the 1st to 3rd hsCRP tertiles. After multivariate adjusted, the results changed slightly and were still significant.

CONCLUSIONS

In a Chinese male population, we firstly confirmed a positive correlation of serum hsCRP with LUTS. It can be inferred that inflammation may be involved in the processes of LUTS.

Prevalence of lower urinary tract symptoms in Austrian males: update 2009

INTRODUCTION

The prevalence of lower urinary tract symptoms (LUTS) in a representative sample of Austrian males aged 15-89 years was assessed in 2009. The results were compared with the findings of a similar study conducted in 1995.

MATERIALS AND METHODS

A population-based cross-sectional survey on LUTS was conducted in 2009 in Austria. A quota sample of 1,926 Austrians was selected. The sample comprised 0.03% of the population and was representative in terms of age, sex, occupational status and area of residence.

RESULTS

Some degree of LUTS is reported by 64.6% of the male population in Austria aged 15-89 years. IPSS correlates significantly with age. In all age groups storage symptoms are more prevalent than voiding symptoms. The prevalence of voiding symptoms (IPSS >0) among Austrian males is 35.5% and the prevalence of storage symptoms is 61.6%. In both groups the prevalence increases with age. Compared to 1995, the prevalence of dissatisfaction declined significantly. An extrapolated number of more than 35,000 men are 'terribly' dissatisfied with their current urinary condition.

CONCLUSIONS

The prevalence of LUTS in Austria meliorated in Austria significantly between 1995 and 2009. This in part may be attributed to intensified contact of males with urologists in the past.

Prostate-specific antigen testing rates remain low in UK general practice: a cross-sectional study in six English cities

OBJECTIVE • To estimate rates of prostate-specific antigen (PSA) testing in UK general practices by age, deprivation index and geographical location. SUBJECTS AND METHODS • Practice-based, retrospective data on PSA testing patterns in 2007 were collected from a random sample of 87 general practices using EMIS LV computer systems within the passively observed non-intervention arm of a cluster-randomized controlled trial. • Information for a total of 126 716 men aged 45-89 years with no recorded diagnosis of prostate cancer prior to 1 January 2007 was collected. RESULTS • In all, 7902 (6.2%) of 126 716 men aged 45-89 without a prior diagnosis of prostate cancer underwent at least one PSA test from their general practitioner during 2007 [95% confidence interval (CI) 5.6-7.0%; practice-based inter-quartile range 3.6-8.4%]. • PSA testing rates were 1.4% (95% CI 1.1-1.6%) in men aged 45-49, rising to 11.3% (95% CI 10.0-12.9%) at age 75-79 years (P for trend <0.001). • Testing rates were lowest in the three northern centres (3.5-5.7%) vs the three more southern centres (7.1-8.9%; P < 0.001). • For every 20 points increase in the index of multiple deprivation score, the proportion of men tested fell by 1.7% (95% CI -2.5 to -0.8%; P < 0.001). • Lower proportions of men were subsequently diagnosed with prostate cancer in practices testing more men (odds ratio for a one unit increase in the natural log of testing 0.76; 95% CI 0.60-0.97; P= 0.025). CONCLUSION • Overall levels of PSA testing in UK general practice remain low, but for those tested there are important variations by age, deprivation and geographical location that do not appear to reflect clinical need or the intention of current policy. • PSA testing in general practice is currently skewed towards older men, and current policy enabling all men to make an informed choice about PSA testing is not being effectively implemented as uptake clearly varies by socioeconomic status. • This reinforces the need for robust evidence regarding the costs and benefits of using the PSA test for the detection of localized prostate cancer in the UK, a full assessment of the health economic implications and a revision of the current policy.

Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men

PURPOSE

To determine the prevalence of, and associated risk factors for, voiding and storage lower urinary tract symptoms (LUTS) in a population-based sample of Australian men.

METHODS

Data were collected from 1,103 men randomly selected, community-dwelling men, as part of the Florey Adelaide Male Ageing Study, after exclusion of men with prostate or bladder cancer or prior surgery to either organ. The presence of LUTS was assessed using the International Prostate Symptom Score. Urine flow was measured via flow meter. Demographic, clinical, and bio-psychosocial data were collected by questionnaire.

RESULTS

The prevalence of total, storage, and voiding LUTS was 18.1, 28.0 and 12.6%, respectively. The most common storage symptoms were frequency (12.3%), nocturia (9.9%) and urgency (8.1%), and voiding symptoms were weak stream (8.5%), intermittency (5.4%), incomplete emptying (5.1%) and straining (2.4%). There were linear associations between storage LUTS and increased abdominal fat mass, plasma glucose and low HDL cholesterol (components of the metabolic syndrome), obstructive sleep apnoea (OSA) risk, and retirement. Voiding symptoms were associated with a previous diagnosis of benign prostatic enlargement (BPH), mean peak urine flow, total energy intake, elevated risk of OSA, erectile dysfunction, physician-diagnosed thyroid dysfunction and higher household income.

CONCLUSIONS

The close association of storage LUTS with the metabolic syndrome, and of both storage and voiding LUTS with OSA, suggest that these conditions should be considered in men presenting with LUTS.

Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of overactive bladder

BACKGROUND

Lower urinary tract symptoms (LUTS) are prevalent among men.

OBJECTIVE

To describe the prevalence, severity, and symptom bother of LUTS in all men and men with overactive bladder (OAB) symptoms in the EPIC study.

DESIGN, SETTING, AND PARTICIPANTS

A secondary analysis of data from EPIC, a multinational population-based survey of 19,165 adults, was performed. Current International Continence Society definitions were used for individual LUTS and OAB; OAB cases were defined as men reporting urgency.

MEASUREMENTS

Participants were asked about the presence of individual LUTS and associated symptom bother. LUTS severity was measured using the International Prostate Symptom Score (IPSS).

RESULTS AND LIMITATIONS

There was substantial overlap of storage, voiding, and postmicturition symptoms among all men (n=7210) and in men with OAB symptoms (n=502); men with OAB symptoms were more likely to experience multiple LUTS subtypes. Among both populations, nocturia was the most commonly reported symptom, except for urgency (the hallmark symptom) among men with OAB symptoms; terminal dribble and sensation of incomplete emptying were the most common voiding and postmicturition symptoms. The prevalence of all LUTS increased with age among the general population; only storage LUTS increased with age among men with OAB symptoms. Number of LUTS and mean IPSS increased with age in both populations but were higher among men with OAB symptoms at all ages; the proportion reporting moderate-severe LUTS was higher than the general population (30% vs 6%). The proportion of men with OAB symptoms reporting symptom bother increased with urgency severity and severity and number of LUTS. LUTS severity may have been underestimated by the IPSS, which does not assess incontinence.

CONCLUSIONS

Men with LUTS commonly experience coexisting storage, voiding, and postmicturition symptoms, emphasizing the need for comprehensive urologic assessments. Men with OAB symptoms reported more LUTS and greater severity than the general population. Symptom bother was related to number of LUTS and urgency severity.

Relationship of lifestyle and clinical factors to lower urinary tract symptoms: results from Boston Area Community Health survey

OBJECTIVES

Because lifestyle factors and comorbidities can influence lower urinary tract symptoms (LUTS) by sex and race/ethnicity differently, we investigated these associations in the Boston Area Community Health survey.

METHODS

Using a multistage stratified cluster random sample, 5506 adults aged 30 to 79 years were enrolled (2301 men, 3205 women, 1770 blacks, 1877 Hispanics, and 1859 whites). Adiposity, lifestyle factors, comorbidities (cardiovascular diseases, diabetes, high blood pressure, high cholesterol, depressive symptoms, previous urinary tract infections) were considered in predicting the odds of LUTS (American Urological Association Symptom Index of 8 or greater) by sex and race/ethnicity.

RESULTS

The prevalence of LUTS was 18.7%, with similar rates by sex (men 18.7%, women 18.6%) and race/ethnicity (black 19.3%, Hispanic 16.2%, white 18.9%); however, the prevalence did increase substantially with age. Depressive symptoms were associated with increased odds of LUTS across all sex and racial/ethnic groups. The overall odds ratio was 2.4 (95% confidence interval 1.9 to 3.2, P <0.001). Age increased the odds of LUTS among all groups. Physical activity decreased the odds of LUTS, particularly in women (odds ratio 0.4, 95% confidence interval 0.2 to 0.7, P = 0.003, comparing high and low activity). Cardiovascular diseases and previous urinary tract infections increased the odds of LUTS overall (odds ratio 1.6, 95% confidence interval 1.2 to 2.1, P = 0.004; and odds ratio 1.9, 95% confidence interval 1.4 to 2.4, P <0.001, respectively) and for most groups.

CONCLUSIONS

The results of this study have shown that the lifestyle and clinical factors associated with LUTS are similar by sex and race/ethnicity.

Incidence and Remission of Female Urinary Incontinence Over 6.5 Years: Analysis of a Health Screening Project

OBJECTIVES

To analyse the incidence and remission of female urinary incontinence (UI) over 6.5 years and to identify risk factors for the development of UI.

METHODS

Women who underwent a health investigation in 1998 or 1999 in the area of Vienna completed the Bristol Female Lower Urinary Tract Symptoms questionnaire. In 2005, all women (n=925) aged >/=20 yr in 1999 who were still living in the area of Vienna were invited to recomplete the questionnaire.

RESULTS

The response rate was 47.7% (n=441; age range, 20-84 yr), and the mean follow-up was 6.5 yr. The overall prevalence of UI was 32% at baseline and increased to 43% in 6.5 years. The mean annual cumulative incidence of UI was 3.9%, with the lowest rate (2.3%) in the youngest age group (20-39 yr) and the highest (7.3%) in those aged 70 yr or older. The mean annual full remission rate was 2.9%, with no clear age dependency. More than half (55.6%) of the women with a full remission had only a mild form of UI at baseline. In a multivariate analysis, urgency (p=0.008) and age (p=0.024) were correlated to the risk of de novo UI.

CONCLUSIONS

This longitudinal study demonstrates that UI is not necessarily a progressive process but rather is a dynamic one.

Prevalence of the Overactive Bladder Syndrome by Applying the International Continence Society Definition

PURPOSE

To determine the prevalence of the overactive bladder (OAB) syndrome in an urban population by using the International Continence Society (ICS) definition and to determine its impact on quality of life and sexual function.

METHODS

Women and men participating in a health screening project in the area of Vienna completed the Bristol Lower Urinary Tract Symptoms (LUTS) questionnaire. To assess the prevalence of OAB the 2002 ICS definition was applied. In addition, all participants underwent a detailed health examination, including physical assessment, evaluation of life style factors, laboratory study and urinalysis.

RESULTS

A total of 1199 men and 1219 women aged 20-91 years were analysed. The prevalence of OAB in men (48.5+/-13.1 years) was 10.2% (OABdry: 8.4%; OABwet: 1.8%) and 16.8% in women (49.5+/-13.5 years; OABdry:10.3%; OABwet: 6.5%). In women, the prevalence of OABdry remained fairly stable over 6 life decades, while OABwet increased substantially after the age of 40 years. In men OABwet and OABdry increased after the third life decade. In men with OAB, 48% did not report a negative impact on quality of life, 36% had minimal, 9.8% moderate and 2.5% severe impairment; the respective percentages for women were 53%, 33%, 7.3% and 6.3%. OABwet had a more profound impact on quality of life. A negative impact of OAB on sexuality was reported by 24% of men and 31% of women.

CONCLUSION

The high prevalence of OAB in this population, its negative impact of quality of life and sexuality underline the importance of this syndrome.

Association between lower urinary tract symptoms and erectile dysfunction

OBJECTIVES

To assess whether the association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is confounded by age or whether LUTS represent an independent risk factor for ED.

METHODS

Men aged 20 to 80 years, who were participating in a health-screening project in the area of Vienna, completed the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5. In parallel, all men underwent a detailed health evaluation, including physical examination, evaluation of various lifestyle factors, and a blood laboratory study with 14 parameters.

RESULTS

Within the total study population (n = 2858; mean age 45.8 years, range 20 to 80), the prevalence of LUTS and ED increased statistically significantly with age (P <0.0001). In multivariate analysis controlling for age, comorbidities, and lifestyle, the IPSS (P = 0.0001), the obstructive score of the IPSS (P = 0.0001), nocturia (P = 0.04), and the LUTS bother score (P = 0.002) correlated statistically significantly with the presence of ED (International Index of Erectile Function-5 score less than 22). The odds ratio for the presence of ED was 2.2 (95% confidence interval [CI] 1.8 to 2.8) for LUTS (IPSS greater than 7), 2.0 (95% CI 1.7 to 2.4) for voiding symptoms, 1.4 (95% CI 1.1 to 1.7) for nocturia (score greater than 2), and 2.5 (95% CI 2.0 to 3.1) for the LUTS bother score.

CONCLUSIONS

The presence of LUTS, in particular voiding symptoms, nocturia, and the quality-of-life impairment due to LUTS, is an independent risk factor for the presence of ED. These findings have implications for the treatment of elderly men with LUTS and open a new area for research.

The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT study

OBJECTIVES

To estimate the prevalence of lower urinary tract symptoms (LUTS) by severity (using the International Prostate Symptom Score, IPSS) in a population-based study of men aged > or = 20 years, and to assess the association between putative risk factors and the presence of moderate to severe LUTS.

SUBJECTS AND METHODS

Between 1995 and 1997, LUTS data were collected from 21 694 male residents aged > or = 20 years in Nord Trøndelag County in Norway, using the IPSS; from the IPSS (score 0-35) LUTS was defined as a score of > or = 8, indicating moderate to severe symptoms. We estimated the prevalence of LUTS and used logistic regression analysis to study lifestyle and anthropometric factors, and comorbidity related to LUTS.

RESULTS

The overall prevalence of moderate to severe LUTS was 15.8% (13.2% moderate and 2.6% severe). The prevalence of LUTS increased strongly with age, from approximately 5% among men aged < 40 years to > 30% when aged > or = 70 years. Factors positively associated with an increased risk of moderate and severe LUTS were anthropometric (body mass index and waist hip ratio) and lifestyle factors (alcohol consumption and smoking), as well as comorbid conditions, including diabetes, history of stroke, muscle complaints and osteoarthritis.

CONCLUSION

The findings from this population-based study suggest that the prevalence of LUTS among men aged > or = 20 years may be lower than previously estimated. Although LUTS may be viewed as an inevitable consequence of ageing, it appears to be exacerbated by lifestyle factors and comorbid conditions.

High rate of prostate symptoms among Ariaal men from Northern Kenya

BACKGROUND

To determine the prevalence and possible determinates of symptomatic benign prostate hyperplasia (BPH) in a subsistence population, the International Prostate Symptom Score (IPSS) was administered to men among the Ariaal, a group of pastoral nomads in Northern Kenya.

MATERIALS AND METHODS

Subjects were 56 nomadic and 62 settled men with estimated ages between 22 and 96. Anthropometric measures included height, percentage body fat, waist circumference, and six skinfolds. Saliva samples for the assay of testosterone were also obtained, as was information about common health complaints.

RESULTS

Rates of lower urinary tract symptoms (LUTS) were extremely high compared to those reported in industrialized societies with 49% of the men classified as having moderate to severe symptoms. The level of LUTS was higher among nomads compared to settled males, and increased with age in both sub-populations. Multivariate logistic regression revealed that suprailliac and trunk skinfold thickness, and report of fever and chest cough were significant and positive predictors of moderate to severe LUTS. When controlled for suprailliac skinfold thickness and other health symptoms, height was also a significant and negative predictor of moderate to severe LUTS. Salivary testosterone was not a predictor of LUTS. Prostate quality of life was strongly related to LUTS, with presence of chest cough as an additional predictor.

CONCLUSIONS

These results suggest that rates of BPH may be high in subsistence populations, as a function of poor nutritional status, both short term and long term. As such, they support a role for energetic balance in the development of BPH, though the potential effects of diet or immune function cannot be ruled out.

Risk behaviours and benign prostatic hyperplasia

OBJECTIVE

To identify risk factors for benign prostatic hyperplasia (BPH).

SUBJECTS AND METHODS

Medical history data, including reported urological conditions and treatments, and risk factor data were collected from 34 694 participants in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a randomized controlled trial designed to evaluate methods for the early detection of cancer.

RESULTS

Asian men had the lowest risks (odds ratio, 95% confidence interval) for nocturia (0.7, 0.5-0.9), physician-diagnosed BPH (0.3, 0.2-0.5) and transurethral prostatectomy (TURP, 0.2, 0.1-0.6), while risks for Whites and Blacks were similar for most measures of BPH. Greater alcohol intake was associated with decreased nocturia (P trend = 0.002), BPH (P trend < 0.001) and TURP (P trend < 0.001). Current tobacco use was associated with decreased nocturia (0.8, 0.7-0.9), BPH (0.7, 0.6-0.8) and TURP (0.6, 0.4-0.8) but dose-response patterns were weak.

CONCLUSION

Asian-Americans have the lowest risk of clinical BPH. Alcohol and possibly cigarettes are related to a lower risk for BPH.

A novel temporary prostatic stent for the relief of prostatic urethral obstruction

OBJECTIVES

To determine the effect of a novel temporary prostatic stent (The Spanner, AbbeyMoor Medical, Inc., Minnesota, USA) on variables of voiding function and quality of life among patients with prostatic urethral obstruction.

PATIENTS AND METHODS

The stent design is very similar to the proximal 4-6 cm of a Foley catheter; this includes a proximal balloon to prevent distal displacement, a urine port situated cephalad to the balloon, and a reinforced stent of various lengths to span most of the prostatic urethra. There is also a distal anchor mechanism attached by sutures, and a retrieval suture which extends to the meatus and deflates the proximal balloon when pulled. The stent was inserted under topical anaesthesia in 30 patients. The maximum flow rate (Qmax), voided volume (W), postvoid residual (PVR), the International Prostate Symptom Score (IPSS) and stent position were assessed.

RESULTS

Stents remained in situ for a mean (range) of 57 (1-98) days. The mean overall Qmax at baseline and after insertion were 8.2 and 11.6 mL/s, representing a 42% improvement (P < 0.001); the respective mean overall Ws were similar, at 219.7 and 221.6 mL (0.9% increase, not significant) and the PVRs were 312.1 and 112.3 mL, representing a 64% decrease (P = 0.004). The overall mean IPSS declined from 22.3 before to 7.1 after insertion, representing a 68% decrease (P < 0.001). There were only minor adverse events. The stability, patency and lack of migration of the device were confirmed radiographically up to 12 weeks of use.

CONCLUSIONS

This early study shows that this temporary prostatic stent is easily inserted and removed, remains anchored in position, and significantly improves the Qmax, PVR and IPSS while preserving volitional voiding and continence.

Prevalence and risk factors for erectile dysfunction in Austria — Analysis of a health screening project

PURPOSE

The aim of this study was to determine prevalence and risk factors for erectile dysfunction (ED) in men undergoing a health investigation.

METHODS

Men aged 30-69 yrs participating in a health screening project in the area of Vienna completed a 11-item questionnaire on ED which was extracted from the international index of erectile function (IIEF). In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors and a blood analysis with 14 parameters.

RESULTS

Within the total study population (n = 832; 45.3 +/- 9.8 yrs), 8.2% reported no sexual intercourse during the previous four weeks, 5.1% reported moderate/severe ED, 13.1% mild and 73.6% no ED. ED, defined as any problem in maintaining erection until the end of sexual intercourse, increased from 12.5% in those aged 30-39 yrs to 15.3% at 40-49 yrs, 27.4% at 50-59 yrs and 45.2% in men 60-69 yrs. In parallel, the percentage of men without sexual intercourse during the previous four weeks increased from 7.4% at 30-39 yrs to 8.8% at 50-59 yrs and 17.0% at 60-69 yrs. By far the strongest correlate for ED was age; other factors were cardiovascular diseases, physical activity and diabetes mellitus.

CONCLUSIONS

This study provides the first estimate of the prevalence of ED in different life decades of men in Vienna, and identifies a number of risk factors for this highly prevalent disorder in ageing men.

The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study

OBJECTIVE

To evaluate the epidemiology of lower urinary tract symptoms (LUTS) among men and women, as there are significant unanswered questions about the prevalence and impact of LUTS in different populations.

SUBJECTS AND METHODS

A population-based, cross-sectional survey was completed in Boxmeer (the Netherlands), Auxerre (France), Birmingham (UK) and Seoul (Republic of Korea), using culturally and linguistically validated versions of the International Prostate Symptom Score (IPSS). The aim was to estimate the distribution of symptoms of LUTS in men and women. Stratified random samples of men aged 40-79 years in each community were collected. Postal questionnaires were used in Europe and direct interviews in Korea.

RESULTS

In all, 4979 index men and 3790 women were recruited, with age-adjusted response rates among men of 72% in Boxmeer, 28% in Auxerre, 60% in Birmingham and 68% in Seoul. The percentages of men and women with an IPSS of 8-35, indicating moderate to severe symptoms, were, respectively, 20.7 and 18.0 (Boxmeer); 19.2 and 12.6 (Auxerre); 25.1 and 23.7 (Birmingham); 16.2 and 19.9 (Seoul). Among women the relationship between symptoms and age was not as strong as in men. The percentages of men and women with moderate to severe symptoms were by age group, respectively, 10.6, 15.5 (40-49); 19.0, 18.2 (50-59); 30.5, 23.8 (60-69); 40.4, 28.7 (70-79). Among those aged 40-49 the main differences between men and women were in the questions about frequency of urination during the day and holding back urine. Among the older groups men reported more symptoms on all questions apart from urination at night and difficulty in holding back urine, both of which were equally prevalent among men and women.

CONCLUSIONS

The overall prevalence of LUTS was high and showed no marked cultural variation. Prevalence increased with age, with severe LUTS commoner in older men. Women reported similar levels of the symptoms traditionally associated with LUTS in men. In each age group there were no major cultural differences in the frequency of LUTS. There were differences with age between men and women; younger men had a lower prevalence of LUTS than younger women but older men a much higher prevalence than older women. These findings emphasize that the IPSS should be confined to within-patient comparisons and not used as a diagnostic tool. The IPSS performs very similarly regardless of gender.

Obesity in relation to prostate cancer risk: comparison with a population having benign prostatic hyperplasia

OBJECTIVE

To analyse the relationship between obesity and prostate cancer, when compared with men with benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

The records were reviewed of consecutive patients with histologically confirmed prostate cancer admitted for prostate surgery between January 1993 and February 1999. Controls were selected from patients who were hospitalized at the same time for the surgical treatment of BPH. One control was matched to each case by age. Obesity was defined as a body mass index (BMI) of> 29 kg/m2.

RESULTS

The study included 194 cases and 194 controls; their median (range) age at operation was 69.5 (50-88) years in both groups, and the BMI 26.1 (16.6-38.1) kg/m2 in the cancer and 25.7 (15.1-36.8) kg/m2 in the BPH group. The difference between the groups was not significant (P = 0.06). Obesity was significantly associated with prostate cancer, with an odds ratio (95% confidence interval) of 2.47 (1.41-4.34). Cases with advanced disease had a higher BMI than those with localized disease, but when age was considered the difference was not significant.

CONCLUSION

In general the BMI was not significantly associated with prostate cancer when compared with men having BPH. However, obese men had 2.5 times the risk of having prostate cancer.

Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men

OBJECTIVES

To estimate the proportion of U.S. men affected by specific lower urinary tract symptoms (LUTS) and to assess whether the prevalence of LUTS varies by race/ethnicity.

METHODS

Included were 30+-year-old men who took part in the Third National Health and Nutrition Examination Survey. Men were asked whether they experienced nocturia, incomplete emptying, or hesitancy. Men 60+ years old were also asked whether they had a decreased urinary stream or had ever undergone noncancer prostate surgery. To obtain the estimated prevalences for the U.S. population, we applied sampling fraction weights. We calculated age-adjusted odds ratios (ORs) of 3+ symptoms or surgery by race/ethnicity using logistic regression analysis.

RESULTS

Only nocturia was common in 30 to 59-year-old men. Among men who had not had prostate surgery, 59.9% of men 60 to 69 years old and 75.1% of men 70+ years old had at least one symptom. All four symptoms were reported by 3.0% of men 60 to 69 years and 5.6% of men 70+ years old. Of the men 60 to 69 years old and men 70+ years old, 8.0% and 22.4%, respectively, reported having undergone surgery. In men 60+ years old, the age-adjusted OR for either having 3+ symptoms or surgery was 0.8 for non-Hispanic black men compared with non-Hispanic white men. The odds of having 3+ symptoms (OR = 1.6), but not surgery (OR = 1.1), appeared greater for Mexican-American men than for non-Hispanic white men.

CONCLUSIONS

Specific LUTS are common in older U.S. men. Older black men were not more likely to have LUTS than were older white men. The apparent modestly higher prevalence of LUTS in older Mexican-American men requires additional study.

Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project

OBJECTIVES

To assess the prevalence of nocturia and its impact on the quality of life in both sexes by analyzing almost 2500 individuals participating in a health survey.

METHODS

During a 12-month period, we included an incontinence questionnaire, which was largely based on the Bristol female lower urinary tract symptoms questionnaire, in the voluntary health examinations in the area of Vienna. In parallel, we recorded the medical history, concurrent medical therapy, physical examination findings, sociodemographic parameters, and blood laboratory study results.

RESULTS

The data of 1247 women (age 49.8 +/- 13.5 years) and 1221 men (age 48.5 +/- 11.9 years) were analyzed. The percentage of individuals with nocturia of two or more times increased constantly with age: less than 30 years, 3.1% of women and 3.4% of men; 30 to 59 years, 7.2% of women and 5. 7% of men; and 60 years old or older, 26.7% of women and 32.4% of men. Age-adjusted extrapolation to the general population (older than 20 years) currently living in Austria yielded that 10.8% of men and 11.8% of women have nocturia of two or more times. Overall, 66. 9% of women and 62.2% of men reported a negative impact of nocturia on their quality of life. The correlation was close between the degree of nocturia with the quality-of-life impairment in both sexes. Several voiding symptoms correlated significantly (P <0.001) with nocturia.

CONCLUSIONS

Nocturia is almost equally present in both sexes, and the incidence and severity increase constantly from early adolescence to senescence. Approximately 10% of the general population (older than 20 years) have nocturia of two or more times, which impairs the quality of life in two thirds.

Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life

The aim of this study was to determine the prevalence of urinary incontinence in both sexes in Austria and to assess its impact on quality of life and sexual function. Voluntary health examinations free of charge are regularly organized in the area of Vienna. From May 1998 to April 1999 we have included in this health examination an incontinence questionnaire containing 37 items, which was largely based on the Bristol female lower urinary tract symptoms (LUTS) questionnaire. This questionnaire asks in detail for various aspects of urinary incontinence/voiding problems, including the impact of urinary incontinence on quality of life and sexual function. In this questionnaire, urinary incontinence was defined as any involuntary loss of urine within the past 4 weeks. The data of 2,498 participants (1,262 women [f]: mean age: 49.7+/-13.6 years and 1,236 men [m]: 48.6+/-13.0 years; age range: 20-96 years) were analyzed. Overall, 26.3% of women and 5.0% of men reported on episodes of urinary incontinence during the past 4 weeks. Prevalence rates increased constantly with age in both sexes: 20-29 years: 4.1% (f), 1.7% (m); 30-39 years: 10.8% (f), 2.7% (m); 40-49 years: 22.9% (f); 3.9% (m); 50-59 years: 34.9% (f), 3.7% (m); 60-69 years: 36.9% (f), 7.6% (m); 70 years or older: 36.0%% (f), 11.5% (m). Overall, 65.7% of women and 58.3% of men stated that quality of life was affected by their incontinence status. A moderate or severe impairment was reported by 18.3% of women and 16.6% of men. Impairment of quality of life was related as statistically significant (P < 0.05) to frequency and degree of incontinence (irrespective of the type of incontinence), the impact on sexual function and need for pads or other incontinence devices. Patient gender, age, and the duration of incontinence had no effect (P > 0.05) on quality of life. An impairment of sexual life by urinary incontinence was stated by 25. 1% of women and 30.5% of women, respectively. Although only 65.7% of women and 58.3% men with urinary incontinence reported on an impairment of quality of life, these data underline the high prevalence and socioeconomic implications of this disorder. The impact of urinary incontinence on quality of life is significantly higher than on sexual function.