Impact of lower urinary tract symptoms on mortality: a 21-year follow-up among middle-aged and elderly Finnish men

Abstract

Background: The usefulness of lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. Repeated assessments are required to take into account symptom fluctuation and de novo symptom appearance. The study objective was to evaluate mortality in relation to three urinary storage symptoms-urgency, daytime frequency and nocturia-in middle-aged and elderly men, considering also other time-varying factors during follow-up. Methods: A mail survey of a population-based cohort of men initially aged 50, 60 and 70 years was conducted in Finland in 1994, 1999, 2004 and 2009. The questionnaire included assessments of LUTS based on the Danish Prostatic Symptom Score and comorbidities. The men were followed up for mortality through the population registry through 2014. LUTS-related hazard ratios (HR) were analyzed with timedependent Cox regression adjusted for the year of birth and comorbidities using variable values updated every five years. Sensitivity analyses were conducted using values of all variables fixed to the baseline assessment of 1994. Results: Of the 1332 eligible men with data on LUTS from each preceding survey, 514 (38.6%) died during the 21-year follow-up. In time-dependent analyses, daytime frequency and nocturia were significantly associated with increased mortality: the adjusted HR was 1.42 (95%CI 1.11-1.83) for daytime frequency, 1.38 (1.07-1.79) for nocturia and 1.19 (0.94-1.50) for urgency. In sensitivity analyses with fixed baseline characteristics, only nocturia was suggestively associated with an increased risk of death: the adjusted HR was 1.09 (0.84-1.42) for daytime frequency, 1.41 (0.99-2.02) for nocturia and 0.94 (0.52-1.68) for urgency. Conclusions: Among aging men, LUTS are more accurate predictors of short-term than longer-term mortality risk. Repeated assessments are needed to detect clinically 3 ill health. Accordingly, men relevant and persistent symptoms, often associated with with daytime frequency or nocturia exhibit a 1.4-fold risk of death and therefore, should be evaluated for underlying comorbidity.

The Impact of Nocturia on Mortality: A Systematic Review and Meta-Analysis

“…Ten original full text articles and 1 conference abstract provided data on nocturia associated death, including 19,590 men and 14,241 women with a total followup of 297,379 person-years (table 1). 21e32 Five of the 11 authors (45%) confirmed the accuracy of our data extraction, 22,25,27,29,31 2 (18%) corrected some errors or provided additional information 26,32 and 4 (36%) were unable respond to our requests for data checks and clarifications. 21,23,28,30 Studies were done on 3 continents in male and mixed gender populations varying widely in age distribution and followup (table 1).…”

Unmet Medical Needs of Patients with Benign Prostate Enlargement

“…BPE, one of the most common diseases in middle-aged men, is a representative disease that causes lower urinary tract symptoms and the enlargement of the prostate gland, which blocks the urethra and induces urinary disorders. BPE, which occurs due to aging and an imbalance of male hormones, may lead to serious complications, such as urethrostenosis, bladder stones, hematuria, acute urinary retention, renal failure, etc., which lowers patients' quality of life [3][4][5].…”

How frequent night-time bathroom visits can negatively impact sleep, well-being and productivity: Examining the associations between nocturia, well-being and economic outcomes in a working-age population

“…In another US study of older men (mean age 74), those who voided three or more times per night had a 21 per cent greater risk of mortality than those with zero to one voids, also after controlling for important covariates (Endeshaw et al, 2016). In Finland, Akerla et al (2018) analysed longitudinal survey data of middle-aged and elderly men and, controlling for important covariates, found that those with nocturia had a 38 per cent greater risk of mortality than those without, where nocturia was defined as two or more voids per night. Nakagawa et al, (2010) analysed the association between nocturia and mortality in a community-based sample of older Japanese individuals (aged 70 years or above), also using longitudinal survey data.…”