Interactions Between Depression and Lower Urinary Tract Symptoms: The Role of Adverse Life Events and Inflammatory Mechanisms. Results From the European Male Ageing Study.

OBJECTIVES: Depression and lower urinary tract symptoms (LUTSs) have been found to co-occur among aging men. The present study attempted to clarify the nature of this relationship, considering adverse life events as potential moderators and the inflammation as an underlying biological mechanism. METHODS: The relationship between depression and LUTS was evaluated using data from the European Male Ageing Study, the largest multicenter population-based study of aging in European men. The sample included 3369 men who were assessed by means of several self-reported questionnaires, including the Beck Depression Inventory-II, the International Prostate Symptom Score, and the Adverse Life Events Scale. Participants were asked to provide information regarding general health and life-style, and medical comorbidities. Biological measures including prostate-specific antigen, testosterone, and C-reactive protein were measured. RESULTS: LUTS and depressive symptoms were correlated (R = 0.32, ß = .10, p < .001), even after adjusting for life-style, psychological, and medical variables. A history of adverse life events was associated with both higher LUTS and Beck Depression Inventory scores. Furthermore, adverse life events moderated the LUTS-depression association (F = 22.62, b = 0.061, p < .001), which increased as a function of the number of life events. C-reactive protein was found to mediate the LUTS-depression association. This mediation effect was moderated by number of adverse life events. CONCLUSIONS: Participants with a history of adverse life events represent a vulnerable population in whom the association between somatic and depressive symptoms is stronger. One of the biological mechanisms underlying this association could be an activation of the central inflammatory signaling pathways.

Benign Prostatic Hyperplasia - An economic assessment of fixed combination therapy based on a literature review.

FederAnziani Senior Italia and SIU - Italian Society of Urology - have decided to work together to draft a document focussing on Benign Prostatic Hyperplasia (BPH), and to stress the importance of adherence with pharmacological treatment in this setting, from both a scientific and a patient standpoint. Starting from a literature search, the two associations analysed to what extent an increase in treatment adherence amongst these patients influences hospital savings and to what extent therapy persistence levels are affected by monotherapy rather than free drug combinations. These estimates were performed only on patients taking medicinal products belonging to the 5 α-reductase inhibitors (5ARI) class that, although not indispensable, are the compounds that bring the greatest benefits, especially in the elderly and for which we know that every additional 30 days of therapy reduced the likelihood of acute urinary retention (AUR) and surgery by 14% and 11% respectively *. The results show that the use of fixed combination therapy would involve an increase in persistence due to the lower rate of patients abandoning treatment over time. Each 30 day-increment of 5ARI therapy, i.e. for an expenditure of 10.6 million euros extra per year for 5ARI medication, savings of approximately 24.3 million euros in hospital costs could be achieved.

The prevalence of lower urinary tract symptoms in a Chinese population, and the correlation with uroflowmetry and disease perception.

OBJECTIVES: To evaluate the prevalence of lower urinary tract symptoms (LUTS) in a population of Chinese men, and its correlation with uroflowmetry and disease perception. MATERIALS AND METHODS: Male volunteers above 40-year old were recruited in the community. Assessment with International Prostatic Symptom Score (IPSS), uroflowmetry, and a quiz on prostatic disease knowledge with 12 true-false-type questions were performed. Correlation of IPSS with uroflowmetry results and prostatic disease knowledge was analyzed. RESULTS: A total of 319 men were recruited for the study, with a mean age of 62 ± 8 years. About 69.3 % of them had moderate-to-severe symptoms on IPSS. A statistically significant correlation was found between IPSS and Q max (r = -0.260, p < 0.001), IPSS and quality of life (r = -0.172, p = 0.002), and IPSS and post-void residuals (r = 0.223, p < 0.001). About 53.0 % of subjects had less than 4 correct answers for the 12 true-false questions. Negative correlation was noted between the number of correct answers and IPSS (r = -0.185, p = 0001). In other words, for the better knowledge on prostatic diseases, the lower IPSS was found. CONCLUSIONS: In a cohort of community-dwelling Chinese men, a significant portion of the population had moderate-to-severe LUTS. While uroflowmetry parameters were found to correlate with IPSS, the degree of knowledge on prostatic diseases also shared a statistically significant correlation with IPSS. This has an implication on the role of urological health education in the future.

Perfiles de severidad en pacientes diagnosticados de hiperplasia benigna prostática en España / Severity Profiles in Patients Diagnosed of Benign Prostatic Hyperplasia in Spain

Objetivos: Analizar los perfiles de severidad y presencia de criterios de progresión en pacientes diagnosticados por primera vez de hiperplasia benigna prostática (HBP) en consultas de Urología. Material y métodos: Estudio observacional, transversal, multicéntrico español, realizado entre mayo y noviembre de 2008, en el que participaron 392 urólogos, que recogieron la información de 3 nuevos pacientes consecutivos con diagnóstico clínico de HBP. Resultados: Se reclutaron un total de 1.115 pacientes. La edad media fue de 65,7 años. El tiempo promedio desde el inicio de los síntomas hasta la consulta fue de 18,8 meses. La media de puntuación IPSS fue de 17,2. Sesenta y tres pacientes (5,7%) presentaron síntomas leves; 670 (60,1%) síntomas moderados con un IPSS medio de 14,6 y 382 (34,3%) síntomas severos con un IPSS medio de 23,7. El PSA promedio fue de 2,6 ng/ml y el volumen prostático ecográfico de 49,2 cc. Setecientos trece pacientes (63,9%) presentaron criterios de progresión (PSA > 1,5 ng/ml y volumen > 30 cc). Se observó una correlación directa de la severidad de los síntomas con la edad, volumen prostático, PSA, criterios de progresión y tiempo de evolución e inversa con el flujo urinario (p < 0,01). La presencia de criterios de progresión se correlacionó directamente con la edad y severidad de los síntomas, e inversamente con el flujo urinario (p < 0,01). Conclusiones: Más del 90% de los pacientes diagnosticados de HBP en las consultas de Urología presentan síntomas moderados o severos. Dos tercios tienen criterios de progresión que se correlacionan con la edad y severidad de los síntomas (AU)

Objectives: To analyse the severity profiles and progression criteria in patients diagnosed of benign prostatic hyperplasia (BPH) in urology clinics in Spain. Material and methods: A multicentre observational epidemiological study conducted in Spain between May-November 2008. A representative sample of 392 urologist gathered socio-demographic, clinical and patient-centered data from three consecutive patients with new diagnostic of BPH in urology clinics. Results: A total of 1.115 patients were evaluated. Mean age was 65.7 years old. Mean time from the onset of symptoms to diagnostic was 18,8 months. Mean IPSS score was 17.2. 63 patients (5,7%) had mild symptoms; 670 (60,1%) had moderate symptoms with a mean IPSS score of 14.6 and 382 (34.3%) had severe symptoms with a mean IPSS score of 23.7. Mean PSA was 2.6 ng/ml and ultrasound measured prostatic volume was 49.2 cc. A total of 713 (63,9%) patients met progression criteria (PSA >1.5 ng/ml and volume > 30 cc). Symptoms severity was directly correlated with age, prostatic volume, PSA, presence of progression criteria and time from the onset of symptoms and inversely correlated with urine flow rate (P < 0.001). Progression criteria was directly correlated with age, symptoms severity and inversely with urine flow rate (P < 0.01).Conclusions: More than 90% of patients diagnosed of BPH in urology clinics in Spain had moderate to severe symptoms. Two thirds met progression criteria that correlate with age and severity of symptoms (AU)

Vitamin D and lower urinary tract symptoms among US men: results from the 2005-2006 National Health and Nutrition Examination Survey.

OBJECTIVE: To evaluate the association of vitamin D levels and lower urinary tract symptoms (LUTS) among US men. MATERIAL AND METHODS: Data were analyzed for 2387 men (≥20 years) who participated in the 2005-2006 cycle of the National Health and Nutrition Examination Survey, a cross-sectional survey of the US noninstitutionalized population. LUTS included nocturia, incomplete emptying, hesitancy, and urinary incontinence (UI). Plasma 25-hydroxyvitamin D was categorized as ≥30 ng/mL (normal), 20-30 ng/mL (insufficiency), and <20 ng/mL (deficiency). Other factors included age, race/ethnicity, education, body mass index, self-reported health status, chronic diseases, and prior diagnosis of benign prostatic enlargement and/or prostate cancer (men ≥40 years of age). Prevalence and prevalence odds ratios (POR) were estimated from a multivariable logistic regression analysis using appropriate sampling weights. RESULTS: A majority (89%, n = 1241) had vitamin D levels <30 ng/mL, of whom 55% (n = 684) had vitamin D levels <20 ng/mL. Vitamin D levels ranged from 2-56 ng/mL (median 19 ng/mL, mean ± SD 19.9 ± 8.0). Among the 1388 (58%) men with LUTS data and vitamin D levels, 48% (n = 666) had at least 1 LUTS. In multivariable analyses adjusting for age and race norms, vitamin D deficiency was associated with the presence of moderate-severe UI (POR 1.8, 95% CI 1.1, 3.0) and at least 1 LUTS (POR 1.4, 95% CI 1.0, 2.0). CONCLUSION: Vitamin D insufficiency and deficiency are highly prevalent among adult men in the US, and vitamin D deficiency is associated with moderate-severe UI and the presence of at least 1 LUTS.

Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men.

PURPOSE: To determine the prevalence of, and associated risk factors for, voiding and storage lower urinary tract symptoms (LUTS) in a population-based sample of Australian men. METHODS: Data were collected from 1,103 men randomly selected, community-dwelling men, as part of the Florey Adelaide Male Ageing Study, after exclusion of men with prostate or bladder cancer or prior surgery to either organ. The presence of LUTS was assessed using the International Prostate Symptom Score. Urine flow was measured via flow meter. Demographic, clinical, and bio-psychosocial data were collected by questionnaire. RESULTS: The prevalence of total, storage, and voiding LUTS was 18.1, 28.0 and 12.6%, respectively. The most common storage symptoms were frequency (12.3%), nocturia (9.9%) and urgency (8.1%), and voiding symptoms were weak stream (8.5%), intermittency (5.4%), incomplete emptying (5.1%) and straining (2.4%). There were linear associations between storage LUTS and increased abdominal fat mass, plasma glucose and low HDL cholesterol (components of the metabolic syndrome), obstructive sleep apnoea (OSA) risk, and retirement. Voiding symptoms were associated with a previous diagnosis of benign prostatic enlargement (BPH), mean peak urine flow, total energy intake, elevated risk of OSA, erectile dysfunction, physician-diagnosed thyroid dysfunction and higher household income. CONCLUSIONS: The close association of storage LUTS with the metabolic syndrome, and of both storage and voiding LUTS with OSA, suggest that these conditions should be considered in men presenting with LUTS.

Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study.

OBJECTIVE: Despite growing interest in overactive bladder (OAB), urinary incontinence (UI), and lower urinary tract symptoms (LUTS), there is no epidemiologic study on the prevalence in general population of Korea. This survey was aimed at estimating the prevalence of OAB, UI, and other LUTS among Korean men and women. METHODS: Population-based cross-sectional telephone survey was conducted between May and September 2006 using questionnaire regarding demographics and the prevalence. A geographically stratified random sample of men and women aged ≥ 18 years were selected. Current International Continence Society definitions were used for individual LUTS and OAB. RESULTS: Of a total of 9,067 individuals contacted, 2,000 (888 men, 1,112 women) agreed to participate. Overall prevalence of LUTS was 61.4% (53.7% of men, 68.9% of women) and the prevalence increased with age. Storage LUTS was more prevalent than voiding or post-micturition LUTS in both men (storage; 44.6%, voiding; 28.5%, post-micturition; 15.9%) and women (storage; 64.4%, voiding; 25.9%, post-micturition; 13.9%). Nocturia was the most frequently reported symptom (36.6% of men, 48.2% of women). Overall prevalence of OAB was 12.2% (10.0% of men, 14.3% of women). UI was reported by 2.9% of men and 28.4% of women. The most prevalent type was other UI in men and stress urinary incontinence in women. CONCLUSIONS: Lower urinary tract symptoms and OAB are prevalent among Korean men and women and the prevalence increases with age. Storage LUTS is more prevalent than voiding or post-micturition LUTS and nocturia is the most common symptom.

Association between erectile function and lower urinary tract symptoms in patients treated with permanent seed prostate brachytherapy.

PURPOSE: Among men who underwent permanent seed prostate brachytherapy, we aimed to: 1) investigate: whether development of lower urinary tract symptoms (LUTS) after permanent seed prostate brachytherapy was associated with suboptimal erectile function before brachytherapy, and 2) identify factors that are associated with normal erectile function before brachytherapy. METHODS AND MATERIALS: We analyzed data from 215 consecutive patients with low- or intermediate-risk prostate cancer who received permanent seed brachytherapy at our center. Erectile function at baseline (prior to brachytherapy) was assessed using the Mount Sinai Erectile Function Score (MSEFS). Urinary symptoms at baseline and at 1 month and 4 months after brachytherapy were measured using the International Prostate Symptom Score (IPSS) questionnaire. Multiple linear regression, and a multivariable mixed linear model were used to analyze differences in IPSS from baseline to 1 month and 4 months after brachytherapy. Multiple logistic regression was used to investigate factors associated with normal erectile function at baseline. RESULTS: A total of 124 patients had data available for baseline, and 1 month and 4 months after brachytherapy. Having normal erectile function (MSEFS of 3) versus suboptimal erectile function (MSEFS 0 to 2) was not associated with increases in IPSS from baseline to 1 month or 4 months after brachytherapy. Larger increases in IPSS were found in subjects who had smaller prostates (regression coefficient = -0.36) or higher seed radioactivity (regression coefficient = 0.33). Patients with higher baseline IPSS were less likely to have normal erectile function (MSEFS = 3) before brachytherapy (odds ratio = 0.88). CONCLUSION: Normal erectile function prior to brachytherapy was not associated with worse IPSS after brachytherapy. However, patients with a higher IPSS before brachytherapy also had worse erectile function before brachytherapy, which may point to a common pathway.

Etiology, epidemiology, and natural history of benign prostatic hyperplasia.

Historically, benign prostatic hyperplasia (BPH) has been a major focus of urologic practice and surgery. But a simplistic causal relationship among prostatic enlargement, progressive obstruction, lower urinary tract symptoms, retention, and complications of retention has been challenged by recognition of the incomplete overlap of prostatic enlargement with symptoms and obstruction. The result has been a greater focus on symptoms than prostatic enlargement and a shift from surgery to medical treatment. Therefore, the question can be asked whether BPH per se, the glandular enlargement as it contributes to bladder dysfunction, or hyperplastic enlargement as a biomarker for generalized lower urinary tract dysfunction are concerns. This article addresses these issues.

Serial prostate biopsies are associated with an increased risk of erectile dysfunction in men with prostate cancer on active surveillance.

PURPOSE: We determined whether serial prostate needle biopsies predispose men to erectile dysfunction and/or lower urinary tract symptoms over time. MATERIALS AND METHODS: Men with prostate cancer on an active surveillance protocol were administered the 5-item Sexual Health Inventory for Men and International Prostate Symptom Score questionnaires on protocol entry, and at a cross-sectional point in 2008. All men had at least 1, 10 to 12-core prostate biopsy at protocol entry and yearly surveillance biopsies thereafter were recommended. RESULTS: Of 333 men 231 returned the followup questionnaires. Correlations were found between biopsy number and erectile dysfunction, with increasing biopsy number associated with a decrease in Sexual Health Inventory for Men score (p = 0.04) and a history of 3 or more biopsies associated with a greater decrease in Sexual Health Inventory for Men score than after 2 or fewer biopsies (p = 0.02). Multivariable analysis for biopsy number, age, prostate volume and prostate specific antigen showed that only biopsy number was associated with decreasing Sexual Health Inventory for Men score (p = 0.02). When men were stratified by baseline Sexual Health Inventory for Men, those without preexisting erectile dysfunction (Sexual Health Inventory for Men score 22 to 25) trended toward steeper decreases in Sexual Health Inventory for Men score after 3 or more biopsies (p = 0.06) than did men with baseline mild to moderate erectile dysfunction (Sexual Health Inventory for Men score 8 to 21). No correlation was found between biopsy number and International Prostate Symptom Score. CONCLUSIONS: Serial prostate biopsies appear to have an adverse effect on erectile function in men with prostate cancer on active surveillance but do not affect lower urinary tract symptoms.

PDE5 inhibitors for LUTS.

To review the current literature regarding the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), and the role of phosphodiesterase-5 (PDE5) inhibitors for the treatment of LUTS. Review of recently published (1990-2009) data regarding epidemiologic and pathophysiologic mechanisms are involved in LUTS-ED, focusing on PDE5 inhibitors particularly evidenced from level 1 clinical trials. Search terms included phosphodiesterase inhibitors, nitric oxide, autonomic hyperactivity, Rho-kinase, atherosclerosis, LUTS, benign prostatic hypertrophy, and ED. Results of several epidemiologic studies show a possible causal relationship between LUTS and ED. Four possible mechanisms have been proposed to explain this association. Multiple large clinical trials have shown a benefit in LUTS after PDE5-inhibitors treatment. PDE5 inhibitors show promise as a future treatment for LUTS, either in conjunction with existing therapies or as a primary treatment.

Alcohol consumption is associated with a decreased risk of benign prostatic hyperplasia.

PURPOSE: While some studies have indicated that alcohol consumption is associated with a decreased risk of benign prostatic hyperplasia, others have not. We evaluated associations of alcohol consumption with benign prostatic hyperplasia and male lower urinary tract symptoms. MATERIALS AND METHODS: We performed a meta-analysis of published studies pertaining to alcohol intake, benign prostatic hyperplasia and lower urinary tract symptoms. We analyzed abstracted data with random effects models to obtain pooled odds ratios of adjusted effects estimates. RESULTS: A total of 19 studies (120,091 men) met selection criteria and of these studies 14 revealed a significantly decreased likelihood of benign prostatic hyperplasia or lower urinary tract symptoms with increased alcohol intake. Sixteen studies were eligible for pooled analyses, of which 12 used benign prostatic hyperplasia as the primary outcome. We stratified total alcohol intake by gm per day into 6 strata. Alcohol intake was associated with a significantly or marginally significantly decreased likelihood of benign prostatic hyperplasia in all 6 strata (p values 0.08, 0.01, <0.001, 0.02, 0.001 and <0.001, respectively). Compared to no alcohol intake, an alcohol intake of 36 gm daily or greater was associated with a 35% decreased likelihood of benign prostatic hyperplasia (OR 0.65, 95% CI 0.58-0.74, p <0.001). Of the 4 studies that used lower urinary tract symptoms as the primary outcome 3 demonstrated a significantly increased likelihood of lower urinary tract symptoms with alcohol consumption. CONCLUSIONS: Alcohol consumption is associated with a decreased likelihood of benign prostatic hyperplasia but not of lower urinary tract symptoms. Further studies are needed to determine the mechanisms by which alcohol modifies the risk of benign prostatic hyperplasia.

Lower urinary tract symptoms, benign prostatic hyperplasia, and obesity.

Obesity has emerged as a global public health challenge. During the past 20 years, there has been a dramatic increase in obesity in the United States. In 2007, only one state had a prevalence of obesity less than 20%. In this growing epidemic of national concern is an emerging relationship between lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH), and obesity. BPH is the most common neoplastic condition afflicting men and constitutes a major factor impacting the health of the American male. Associations among obesity, physical inactivity, and BPH/LUTS resulting from epidemiological studies have not been explored via clinical trial methodology. A review of the available data appears to support a strong independent relationship between obesity and BPH/LUTS. This review also indicates that gene expression within the prostate varies with prostate size and can be affected by lifestyle modifications. Future studies may lead to office detection of a patient's particular polymorphisms, which may help guide individual treatment and lifestyle modifications that are more likely to succeed.

The prevalence of erectile dysfunction among Brazilian men screened for prostate cancer.

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) in a large cohort of Brazilian men who were screened for prostate cancer, and to determine risk factors in this population, as there are large cultural differences among countries in reporting the frequency of ED, and it is likely that the prevalence of ED among men screened for prostate cancer cannot be generally applied across countries. SUBJECTS AND METHODS: The analysis focused on the baseline characteristics of 1008 consecutive South American men from Brazil with no known prostate disease who had routine screening for prostate cancer by urologists. The variables analysed were patient age, urinary symptoms, patient health-related quality of life (HRQL), prostate-specific antigen (PSA) levels, prostate volume and erectile function. To assess lower urinary tract symptoms (LUTS) and HRQL, we used the American Urological Association symptom score and its appended eighth question, respectively. Benign prostatic hyperplasia was defined as a prostate volume of >30 g. Sexual function was assessed using the five-item version of the International Index of Erectile Function questionnaire. Thus, ED was considered to absent for scores of 22-25, mild for 17-21, mild to moderate for 12-16, moderate for 8-11, or severe for 5-7. Obesity was defined by calculating the body mass index (BMI), and categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) or obese (= 30 kg/m(2)). The mean (sd) PSA level was 4.3 (6.7) ng/mL and the mean prostate volume 37.8 (21.8) mL. The correlation of ED with these variables was estimated using unconditional logistic regression models. RESULTS: Information about erectile function was available for 908 patients. ED was considered to be absent, mild, mild to moderate, moderate and severe in 169 (18.6%), 210 (23.1%), 169 (18.6%), 138 (15.2%) and 222 (24.5%) patients, respectively. The ED was severe in 18.4%, 25.7% and 43.4% of patients with mild, moderate and severe LUTS, respectively (P < 0.001). The answer to the HRQL question was also significantly associated with ED; ED was severe in 16.5% of patients feeling delighted/pleased and in 35.8% of patients feeling unhappy/terrible (P < 0.001). The prostate volume was significantly related to ED. The BMI category showed that normal weight, overweight and obese patients had similar rates of ED (P = 0.415); ED was severe in about a quarter of the patients in each of these categories, and 50% and 24% of patients in the underweight and greater BMI groups had severe ED, respectively. CONCLUSIONS: Of men screened for prostate cancer in Brazil, approximately 40% have moderate or severe ED. Severe LUTS, higher HRQL scores, a large prostate volume, a low BMI and higher PSA levels might be associated with higher rates of ED. These variables should be considered when analysing the erectile function of patients screened for prostate cancer.

[Prevalence of lower urinary tract symptoms related with benign prostatic hyperplasia. Study of 1804 men aged 40 or older in Madrid]. / Prevalencia de síntomas del tracto urinario inferior relacionados con la hiperplasia benigna de próstata. Estudio de 1804 hombres de 40 años o más residentes en Madrid durante 1999-2000.

INTRODUCTION: Lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH) are present nowadays in approximately 20 to 30% of the Spanish male population from the age of 50 onwards. The purpose of this study was to assess clinical and epidemiological characteristics of patients with LUTS. METHODS: A cross-sectional study was performed, between 1999 and 2000, among 1,804 men aged 40 or older who were living in Madrid. Subjects were interviewed by telephone; socio-demographic information was requested and the presence of LUTS was assessed using the International Prostate Symptoms Score. Informed consent was requested, Association between qualitative variables was evaluated by chi2 or Fisher's test. A logistic regression model was performed to control confusion. RESULTS: Prevalence of moderate/severe LUTS was 16.6% (95%CI: 14.8-18.3). Nearly 90% of the subjects consumed olive oil, 71.5% alcohol, 63.1% did not smoke and 96.9% did not consume drugs. A 27.7% of the subjects had hypertension and 8.8% referred diabetes. Men aged 70 or older had a threefold increased frequency of serious symptoms compared to younger men (OR: 3.31; 95%CI: 2.10-5.22). Low level of studies increased this frequency by a factor of 2.2 (95%CI: 1.42-3.46) and men who consumed only seed oil had twice more serious symptoms than those who consumed olive oil (OR: 1.86; 95%CI: 0.98-3.55). CONCLUSIONS: Family history of urological diseases, age, low level of studies, hypertension, diabetes and seed oil consumption were independently associated with more serious symptoms, while medium alcohol consumption and mild smoking habit were associated with slighter symptoms.

The impact of lower urinary tract symptoms on male sexual health: EpiLUTS.

OBJECTIVE: To evaluate the association between International Continence Society categories of lower urinary tract symptoms (LUTS; storage, voiding, and postmicturition) and individual LUTS (associated with decreased sexual activity and sexual satisfaction in men) with erectile dysfunction (ED), ejaculatory dysfunction (EjD) and premature ejaculation (PE). SUBJECTS AND METHODS: The impact of LUTS on men's sexual health was captured as part of a cross-sectional epidemiological study to assess the prevalence LUTS among men and women aged > or =40 years in the USA, the UK and Sweden. RESULTS: The analysis included 11 834 men with a mean age of 56.1 years, 71% of whom reported being currently sexually active. The primary reason for not being sexually active was no partner (35%), followed by personal health (23%) and no desire (23%). Of the men, 26% had mild to severe ED, 7% had EjD, and 16% PE. Men with multiple LUTS had more severe ED and more frequent EjD and PE. Logistic regression analysis showed that greater age, hypertension, diabetes, depression, urgency with fear of leaking, and leaking during sexual activity were significantly associated with ED. The results were similar in the logistic regression analysis for EjD, whereas being younger and the absence of prostatitis were significantly associated with PE, as were the presence of terminal dribble, incomplete emptying, and split stream. CONCLUSION: LUTS are associated with common sexual dysfunctions in men. The results of this study highlight the importance of assessing the sexual health of men presenting with LUTS.

Rationale for the study methods and design of the epidemiology of lower urinary tract symptoms (EpiLUTS) study.

Accurate prevalence data on illnesses are of paramount importance for medical decision-making, healthcare planning, and the appropriate allocation of healthcare resources. When assessing the prevalence of any illness or health condition, it is important to base prevalence data on an assessment of the general population at large and not on selected groups of the population. Previous estimates of the prevalence of lower urinary tract symptoms (LUTS) have used postal surveys, telephone and in-person interviews, and, more recently, the Internet. Determining the mode of data collection for a research study is dictated by several factors, including target population, topic sensitivity, timeliness, and available resources. The purpose of this report is to document the rationale for conducting a large prevalence study of LUTS and its impact on patient outcomes using Internet- or Web-based surveys. A brief overview of important survey considerations is provided, and previous survey methods used in assessing the prevalence of LUTS discussed. The research objectives and sampling approach used in the EpiLUTS study in the USA, the UK and Sweden are presented, with a discussion of the advantages and disadvantages of this Internet-based sampling approach in relation to other epidemiological methods.

The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study.

OBJECTIVE: To estimate and compare the prevalence and associated bother of lower urinary tract symptoms (LUTS) in the general populations of the USA, UK and Sweden using current International Continence Society (ICS) definitions, as no previous population-based studies evaluating the prevalence of LUTS in the USA, using the 2002 ICS definitions, have been conducted. SUBJECTS AND METHODS: This cross-sectional, population-representative survey was conducted via the Internet in the USA, the UK and Sweden. Members of Internet-based panels were randomly selected to receive an e-mailed invitation to participate. If interested, respondents selected a link to an informed consent page, followed by the survey. Participants were asked to rate how often they experienced individual LUTS during the previous 4 weeks, on a five-point Likert scale, and, if experienced, how much the symptom bothered them. Descriptive statistics were used to summarize and present the data. RESULTS: Responses rates for the USA, the UK and Sweden were 59.6%, 60.6% and 52.3%, respectively, with a final sample of 30,000 (USA 20,000; UK 7500; Sweden 2500). The mean age (range) of the participants was 56.6 (40-99) years; the mean percentages for race were 82.9% white, 6.7% black, 6.0% Hispanic and 4.4% Asian/other. The prevalence of LUTS was defined by two symptom frequency thresholds, i.e. at least 'sometimes' and at least 'often' for all LUTS except incontinence, where frequency thresholds were at least 'a few times per month' and at least 'a few times per week'. The prevalence of at least one LUTS at least 'sometimes' was 72.3% for men and 76.3% for women, and 47.9% and 52.5% for at least 'often' for men and women, respectively. For most LUTS, at least half of the participants were bothered 'somewhat' or more using a frequency threshold of at least 'sometimes'. For a threshold of at least 'often', 'somewhat' or more bother was reported by > or =70% of participants except for terminal dribble in men and split stream in women. CONCLUSION: In this large population study of three countries, LUTS are highly prevalent among men and women aged >40 years. In general, LUTS experienced 'often' or more are bothersome to most people.

Lower urinary tract symptoms increase the risk of falls in older men.

OBJECTIVE To evaluate the association of lower urinary tract symptoms (LUTS) with the risk of falls in elderly community-dwelling men. SUBJECTS AND METHODS We evaluated 5872 participants in the Osteoporotic Fractures in Men, a prospective cohort study of risk factors for falls and osteoporotic fractures among community-dwelling men aged > or =65 years. The primary outcome was the 1-year cumulative incidence of falls in men with moderate or severe, vs mild LUTS at baseline, as measured by the American Urological Association Symptom Index. We used Poisson regression models and considered multiple variables as potential confounders. RESULTS At baseline, 3188 (54%) reported mild, 2301 (39%) moderate, and 383 (7%) severe LUTS. Compared with men who had mild symptoms, the adjusted 1-year cumulative incidence of falls was significantly higher among men with moderate or severe LUTS. The risk of at least one fall was increased by 11% among those with moderate (relative risk 1.11, 95% confidence interval, CI, 1.01-1.22; P = 0.02) and by 33% among those with severe LUTS (1.33, 1.15-1.53; P < 0.001). Further, those with moderate LUTS had a 21% (1.21, 1.05-1.40; P = 0.01) and those with severe LUTS a 63% (1.63, 1.31-2.02; P < 0.001) greater risk of at least two falls. LUTS most strongly associated with falls were urinary urgency, difficulty initiating urination, and nocturia. CONCLUSIONS Moderate and severe LUTS independently increase the 1-year risk of falls, particularly recurrent falls, in community-dwelling older men. Because of the serious consequences of falls, these results might justify the routine assessment of LUTS with a validated questionnaire in the primary care of this population.