Lower Urinary Tract Symptoms and Mortality among Finnish Men: The Roles of Symptom Severity and Bother

Abstract

Purpose:The utility of male lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. We explored LUTS-associated mortality among Finnish men, evaluating the association of symptom severity and bother with risk of death.Materials and Methods:A questionnaire including the Danish Prostatic Symptom Score was mailed to a population-based cohort of 3,143 men aged 50, 60 and 70 years in 1994, with repeat surveys in 1999, 2004, 2009 and 2015. The men were followed until the end of 2018. Mortality associated with LUTS was analyzed using time-dependent Cox regression adjusted for age and comorbidity, updating symptom data every 5 years, including interaction terms between symptoms and associated bother.Results:Of the 1,167 men in the analysis, 591 (50.6%) died during the 24-year followup. In analyses of moderate and severe symptoms disregarding bother, overall voiding and storage LUTS, daytime frequency and urgency incontinence were associated with increased mortality: the multivariable-adjusted hazard ratios were 1.19 (95% CI 1.00–1.40), 1.35 (1.13–1.62), 1.31 (1.09–1.58) and 2.19 (1.42–3.37), respectively. In analyses disregarding symptom severity and bother, voiding LUTS were associated with decreased mortality, while daytime frequency and nocturia were associated with increased mortality: the HRs were 0.82 (95% CI 0.67–1.00), 1.31 (95% CI 1.09–1.58) and 1.52 (95% CI 1.21–1.91), respectively. Excess mortality associated with bothersome daytime frequency and nocturia tended to be slightly higher: the HRs were 1.86 (95% CI 1.41–2.47) and 1.88 (95% CI 1.38–2.58), respectively. No significant interactions were found between symptoms and associated bother, however.Conclusions:Moderate and severe LUTS are potential risk factors for mortality, independently of their bother.

Canadian Urological Association best practice report: Diagnosis and management of nocturia

“…4 This association of nocturia with mortality has been reported to be independent of bother, and should be noted even if patients are not bothered. 5 Patients therefore may benefit from assessment for nocturia even if they don't independently report nocturia, as bother is often what motivates patients to raise nocturia as an issue with their care providers.…”

“…4 This association of nocturia with mortality has been reported to be independent of bother, and should be noted even if patients are not bothered. 5 Patients therefore may benefit from assessment for nocturia even if they don't independently report nocturia, as bother is often what motivates patients to raise nocturia as an issue with their care providers.Depending on the patient population and definition of nocturia used, prevalence varies significantly. [6][7][8] From a Canadian survey of 1000 adults, prevalence, using the ICS definition of one or more episodes per night, was estimated to be 36.4% in all adults and 49.5% in adults over age 65.…”

Association of nocturia with estimated glomerular filtration rate: a cross-sectional study from the NHANES 2005-2018

“…Besides, cardiovascular disease was substantially connected with the prevalence of nocturia, and the risk for cardiovascular disease increased as nocturia severity increases [8]. Importantly, moderate and severe symptoms of the lower urinary tract are possible mortality risk factors [9]. A review on the Kidney Disease Quality of Life (KDQOL-36) identi es increased urination (including nocturia) as a prominent symptom in patients with chronic kidney disease stages 2-3b [10].…”

This Month in Adult Urology

“…A ˚kerla et al (page 1285) from Finland further explore this concept among middle-aged and elderly men utilizing population-based surveys spanning 1994e2018. 1 Their analysis included 1,167 men and demonstrates an association of daytime frequency and nocturia with increased mortality. Although no cause-effect correlation can be inferred from these observations, the authors interestingly show this link between LUTS and mortality is independent of associated bother, which might be the more usual complaint to drive subsequent investigation and management.…”