Relationship between lifestyle and health factors and severe lower urinary tract symptoms (LUTS) in 106,435 middle-aged and older Australian men: population-based study

Abstract

Background: Despite growing interest in prevention of lower urinary tract symptoms (LUTS) through better understanding of modifiable risk factors, large-scale population-based evidence is limited.

Objective: To describe risk factors associated with severe LUTS in the 45 and Up Study, a large cohort study.

Design, setting, and participants: A cross-sectional analysis of questionnaire data from 106,435 men aged ≥ 45 years, living in New South Wales, Australia.

Outcome measures and statistical analysis: LUTS were measured by a modified version of the International Prostate Symptom Score (m-IPSS). The strength of association between severe LUTS and socio-demographic, lifestyle and health-related factors was estimated, using logistic regression to calculate odds ratios, adjusted for a range of confounding factors.

Results: Overall, 18.3% reported moderate, and 3.6% severe, LUTS. Severe LUTS were more common among men reporting previous prostate cancer (7.6%), total prostatectomy (4.9%) or having part of the prostate removed (8.2%). After excluding men with prostate cancer or prostate surgery, the prevalence of moderate-severe LUTS in the cohort (n = 95,089) ranged from 10.6% to 35.4% for ages 45-49 to ≥ 80; the age-related increase was steeper for storage than voiding symptoms. The adjusted odds of severe LUTS decreased with increasing education (tertiary qualification versus no school certificate, odds ratio (OR = 0.78 (0.68-0.89))) and increasing physical activity (high versus low, OR = 0.83 (0.76-0.91)). Odds were elevated among current smokers versus never-smokers (OR = 1.64 (1.43-1.88)), obese versus healthy-weight men (OR = 1.27 (1.14-1.41)) and for comorbid conditions (e.g., heart disease versus no heart disease, OR = 1.36 (1.24-1.49)), and particularly for severe versus no physical functional limitation (OR = 5.17 (4.51-5.93)).

Conclusions: LUTS was associated with a number of factors, including modifiable risk factors, suggesting potential targets for prevention.

Figure 1. Prevalence of Lower Urinary Tract Symptoms (LUTS) by age group among men aged 45 and over.*

Figure 1 displays the prevalence of each Lower Urinary Tract Symptom (LUTS) as it increased with each increase in age group (Fig 1). We excluded all men with prostate cancer or previous prostate surgery from this figure to demonstrate the effect of ageing on LUTS. Most notably nocturia (needing to void 3 or more times per night) increased from 2% in men aged 45–49 to 24% in men aged 80 years and over. *Excluding men with prostate cancer or previous prostate surgery.

Figure 2. Proportion of men aged 45 and over with severe overall LUTS and high storage and voiding symptom scores, by age.*

Figure 2 displays the prevalence of high storage symptom scores (scoring 6 or more on the modified International Prostate Symptom Score (m-IPSS)), high voiding symptom scores (m-IPSS of 6 or more), and high overall LUTS scores (m-IPSS of 12 or more) as it increased with each increase in age group (Fig 2). We excluded all men with prostate cancer or previous prostate surgery from this figure to demonstrate the effect of ageing on LUTS. High storage problems were more common than voiding symptoms at or above 60 years old. *Excluding men with prostate cancer or previous prostate surgery.