Moderate and severe male lower urinary tract symptoms (LUTS) may be potential markers of poor overall health and a risk factor for mortality among middle-aged and elderly men regardless of whether the symptoms are bothersome, a recent study suggests.
“Although male LUTS have been proposed as risk factors for morbid events, the associations between LUTS and mortality should be generally considered as proxies of ill health,” corresponding author Jonne Åkerla, MD, of Tampere University in Finland, and colleagues reported in The Journal of Urology. “This indicates the importance of assessing the general health, risk factors and major comorbidities among men with LUTS.”
In the Tampere Aging Male Urological Study, Dr Åkerla’s team mailed a survey that included the Danish Prostatic Symptom Score questionnaire to 3143 Finnish men (aged 50, 60, and 70 years) in 1994, with repeat surveys in 1999, 2004, 2009, and 2015. A subset of 1167 men were followed through 2018. Over the 24-year period, 591 (50.6%) of men in the subset died.
Men with moderate or severe voiding LUTS had a 1.2-fold increased risk of death and those with storage LUTS had a 1.4-fold higher risk. Men with daytime frequency and those with nocturia had a 1.3- and 1.5-fold increased risk for death independent of symptom severity.
“This suggests considering daytime voiding interval of 3 hours or less and any nighttime voiding as patient-important especially when appearing as persistent symptoms,” the authors wrote.
In addition, the investigators observed a 2.2-fold increased risk of death among men with frequent urgency incontinence. This particularly strong association suggests that urinary urgency has a significant impact on health and functional status in aging men, possibly reflecting the effects of long-term neurologic and vascular disease, they explained.
“While the association between LUTS and mortality is largely explained by the comorbidities in men with LUTS, the fact that the association remained even after adjustment for age and comorbidity shows that other, currently unidentified factors increasing the risk of death are also involved,” the authors wrote.
In a discussion of study limitations, the investigators noted that there were no bladder diaries, so they were unable to further characterize the association between urinary frequency and mortality and whether daytime frequency and nocturia were due to global/nocturnal polyuria or possibly reduced bladder capacity or even caused by a mixed etiology.
Short-term studies suggest treatment of male LUTS improves quality of life, but there are no randomized trials that have examined the impact of treating LUTS on morbidity or mortality, according to the investigators. The roles of daytime frequency and nocturia as mortality risk factors independent of symptom severity indicates they may be useful markers.
Studies such as these “highlight the importance of managing LUTS, and also to facilitate studies to understand the underlying process, which can lead to improved strategy for treating LUTS,” Amy Zhang, PhD, an associate professor in the department of urology at Case Western Reserve University in Cleveland, Ohio. “There are best practice guidelines for treatment, but treatment may or may not be effective and patients may or may not continue treatment. So, management of LUTS is not optimal.”
“The association of even moderate symptoms with mortality is a little surprising,” said Yair Lotan, MD, professor and chair of urology at the University of Texas Southwestern Medical Center at Dallas, Texas, who was not part of the current study. “What is not clear is whether treating these symptoms will reduce mortality.” He pointed out, however, that the study was conducted in Finland so the findings are not necessarily a reflection of US practices.
Åkerla J, Pesonen JS, Pöyhönen A, et al. Lower urinary tract symptoms and mortality among Finnish men: The roles of symptom severity and bother. J Urol. Published online April 26, 2022. doi:10.1097/JU.0000000000002450