The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health‐related quality of life, anxiety and depression: EpiLUTS

Abstract

perception of bladder problems, anxiety and depression. RESULTSThe overall survey response rate was 59.2%; 30 000 subjects (14 139 men and 15 861 women) participated. Men and women with LUTS in the all LUTS subgroup (storage, voiding and postmicturition) reported the lowest levels of HRQL and highest levels of anxiety and depression, with 35.9% of men and 53.3% of women meeting self-reported screening criteria for clinical anxiety (Hospital Anxiety and Depression Scale, HADS, Anxiety ≥ 8), and 29.8% of men and 37.6% of women meeting self-reported criteria for clinical depression (HADS Depression ≥ 8). In both men and women, storage symptoms were significantly associated with greater perceived bladder impact, whereas voiding symptoms were not. Significant predictors of anxiety included nocturia, urgency, stress urinary incontinence, leaking during sexual activity, weak stream and split stream in women; and nocturia, urgency, incomplete emptying and bladder pain in men. For depression, weak stream, urgency and stress urinary incontinence were significant for women, and perceived frequency and incomplete emptying were significant for men. CONCLUSIONThe negative effect of LUTS is apparent across several domains of HRQL and on overall perception of bladder problems, general health status and mental health. The high level of psychiatric morbidity in patients with multiple LUTS has important implications for treatment and highlights the need for further research to pinpoint specific mechanisms underlying this association. KEYWORDSLUTS, depression, anxiety, health-related quality of life, OAB, BPH, burden OBJECTIVETo evaluate the impact of lower urinary tract symptoms (LUTS) on urinary-specific healthrelated quality of life (HRQL), generic health indices, depression and anxiety in a population-representative sample of men and women, as research has linked LUTS with reduced HRQL and depression, but little is known about the effects of individual LUTS on HRQL, depression and anxiety.

Drug treatment patterns for the management of men with lower urinary tract symptoms associated with benign prostatic hyperplasia who have both storage and voiding symptoms: a study using the health improvement network UK primary care data

“…Initial treatment with a 1 -blocker monotherapy may not adequately control symptoms in men with storage symptoms based on data which reported only 35% of men had improved symptoms with a 1 -blocker monotherapy, whilst a 1 -blocker plus antimuscarinic combination therapy improved symptoms in 73% of those men who did not initially respond to a 1 -blocker monotherapy 19 . Combined, these data suggest that some men with storage symptoms may be inadequately treated in clinical practice, especially given these symptoms are particularly bothersome 2 and can significantly affect HRQoL 6 . Large randomized and controlled clinical studies have shown combination therapy with an a 1 -blocker and an antimuscarinic agent to be effective and well tolerated in men with moderate-to-severe LUTS and documented storage symptoms [8][9][10][11][12][13] .…”

“…The UK National Institute for Health and Care Excellence (NICE) estimates that 90% of men 50 to 80 years of age experience troublesome LUTS, with storage symptoms increasing from 3% at age 40-44 years to 42% from 75 years 1 . The resource burden of LUTS 5 is accompanied by loss of health-related quality of life (HRQoL), including significant effects on general health status and mental health 6 . In the worst cases, sleep may be disturbed by nocturia up to 10 times a night 5 .…”

Lower urinary tract symptoms and benign prostatic hyperplasia and their impact on quality of life

“…16 It evaluated 30,000 subjects from the United States, United Kingdom and Sweden and found that 35% of subjects met the criteria for a clinical state of anxiety and 29.8% for a clinical state of depression. Nycturia, urgency, incomplete voiding and physical pain were found to be risk factors for anxiety, whereas urination frequency and incomplete voiding were found to be risk factors for depression.…”

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

“…1 In terms of mental health, it is estimated that approximately one-third of men and women with lower urinary tract symptoms may have comorbid clinical anxiety and/or depression. 9 In addition, it has been shown that the prevalence of depression in those with OAB is two-fold higher than in the general population (10.5% vs. 4.9%, respectively; p<0.0001). 10 At a societal level, OAB is associated with substantial healthcare costs.…”

“…9 In addition, it has been shown that the prevalence of depression in those with OAB is two-fold higher than in the general population (10.5% vs. 4.9%, respectively; p<0.0001).…”