Beyond the lower urinary tract: the association of urologic and sexual symptoms with common illnesses

Abstract

Objective: In addition to being prevalent and bothersome, urologic and sexual symptoms may be related to chronic medical illnesses. We investigate the relationship between ten urologic and sexual symptoms and four major illnesses (type II diabetes, cardiac disease, hypertension, and depression).

Methods: We analyzed data from the Boston Area Community Health (BACH) survey, a community-based epidemiologic study of urologic symptoms and risk factors. BACH used a two-stage stratified cluster sampling design to recruit 5,506 adults aged 30-79 (2301 men, 3205 women; 1770 black, 1877 Hispanic, and 1859 white).

Results: In bivariate analyses, most urologic and sexual symptoms were associated with type II diabetes, cardiac disease, hypertension, and depression. However, in multivariate models adjusting for all four illnesses, gender, race/ethnicity, age, alcohol intake, smoking, physical activity, and body mass index there were fewer significant associations. We found that all urologic symptoms were significantly related to at least one illness, with depression increasing the odds of all urologic and sexual symptoms studied.

Conclusions: Urinary tract specialists should consider factors outside the urinary tract that may be contributing to urologic symptoms. It remains unknown whether treatment of medical and psychological illnesses can result in meaningful improvement in urologic symptoms, or conversely, whether urinary tract symptoms can provide valuable insight into an individual's overall health status.

FIGURE 1. THE CONSISTENT RELATIONSHIPS BETWEEN TEN UROLOGIC AND SEXUAL SYMPTOMS AND FOUR ILLNESSES (TYPE II DIABETES, CARDIAC DISEASE, HYPERTENSION AND DEPRESSION) BY GENDER

LEGEND: SQUARE (MEN), TRIANGLE (WOMEN), CIRCLE (OVERALL), BLACK (GRAY) FIGURES INDICATE THAT A P VALUE FROM A CHI-SQUARE TEST OF INDEPENDENCE IS LESS THAN (GREATER THAN) 0.05 EXPLANATION: The prevalence of twelve urologic symptoms is plotted as a function of the presence or absence of four illnesses (type-II diabetes, cardiac disease, hypertension, depression). Each symptom’s estimates are given in two horizontal rows, the first row (marked “No”) applying to subjects who do not exhibit the illness denoted in the relevant column heading, and the second (marked “Yes”) applying to those subjects who do suffer from that illness. Numeric values corresponding to the symptom prevalence estimates are given in the horizontal axis presented at the bottom of each column. Estimates for men and women combined are denoted by circular symbols, for women alone by triangles, and for men alone by squares. For each urologic symptom/illness combination, the two estimates for men and women combined are connected with a line segment, the length of which indicates the increase in prevalence of the symptom that is associated with the presence of the illness. Where this increase is statistically significant, the corresponding prevalence estimates are presented with black symbols, while statistically insignificant associates are indicated by estimates presented in grey. With the exception of the FSD/diabetes combination, each symptom is positively, though not always significantly, associated with every illness, as evidenced by the fact that all line segments (save that corresponding to the FSD/diabetes combination) exhibit a negative slope. That every symptom is significantly associated with depression, both within each gender and overall, is indicated by the fact that all symbols in the last column of the figure are drawn in black.

FIGURE 2. ODDS RATIOS (WITH 95% CONFIDENCE INTERVALS) DEPICTING THE ASSOCIATIONS BETWEEN TEN UROLOGIC AND SEXUAL SYMPTOMS AND FOUR ILLNESSES (TYPE II DIABETES, CARDIAC DISEASE, HYPERTENSION AND DEPRESSION)

LEGEND: O (OVERALL), M (MEN), F (WOMEN). THE ODDS RATIOS ARE ESTIMATED FROM A MULTIVARIATE MODEL INCLUDING TYPE II DIABETES,CARDIAC DISEASE, HYPERTENSION, DEPRESSION, AGE, RACE/ETHNICITY, GENDER, ALCOHOL CONSUMPTION, SMOKING, PHYSICAL ACTIVITY AND BODY MASS INDEX. NOTE THAT THE ODDS RATIO SCALE GOES TO 25 FOR PBS ONLY. EXPLANATION: Point (squares) and 95% confidence interval (line segments) estimates for the multiplicative increase in odds of subjects’ experiencing individual urologic symptoms that is associated with the presence of specific illnesses. The illnesses are organized into columns as indicated at the bottom of the figure. Estimates are given for men and women together ( “O”), men only (“M”), and women subjects only (“F”). For each symptom, a horizontal line has been drawn to indicate the location of a hypothetical odds ratio of 1.0, which would denote no association between the relevant symptom and illness. Confidence intervals that do not cross these horizontal axes indicate statistically significant evidence of association between symptom and illness.