Nocturia, Daytime Urinary Frequency Linked With Mortality

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Men with nocturia have a 1.4-fold greater risk of death than men without nocturia, after adjustment for age and major comorbidities.
Men with nocturia have a 1.4-fold greater risk of death than men without nocturia, after adjustment for age and major comorbidities.

Middle-aged and elderly men with certain lower urinary tract symptoms (LUTS), especially nocturia and daytime urinary frequency less than 2 hours, have a greater short-term risk of dying, according to new study findings published in Prostate Cancer and Prostatic Diseases.

As part of the Tampere Ageing Male Urological Study (TAMUS), investigators asked Finnish men older than 50 years to complete health questionnaires by mail every 5 years (1994, 1999, 2004, and 2009) to evaluate the fluctuation and development of symptoms and comorbidities. Investigators used the Danish Prostatic Symptom Score to evaluate lower urinary tract symptoms (LUTS).

Of 1332 men, 514 (38.6%) died during 21 years of follow-up, Jonne Åkerla, MD, of Central Finland Central Hospital in Jyväskylä, and colleagues reported. In multivariable-adjusted time-dependent analyses, nocturia (3 or more voids per night) and daytime urinary frequency less than 2 hours were associated with a significant 38% and 42% increased risk of death, respectively. After sensitivity analyses accounting for baseline characteristics, nocturia was “suggestively associated” with a 1.4-fold increased risk for death.

The results are in line with previous research showing 1.3-fold greater risk for death. 

“Although urinary symptoms are common in aging men, they may also be markers of ill health,” Dr Åkerla's group noted. “Investigations for underlying comorbidity are warranted particularly in cases of persistent and treatment-resistant symptoms.”

The authors concluded that LUTS are more accurate predictors of short-term rather than longer-term mortality risk among aging men. “Repeated assessments are needed to identify clinically relevant and persistent symptoms, often associated with ill health,” they wrote.

They also recommended that management of men with LUTS “should focus not only on treating the symptoms, but also assessing their general health, risk factors and major comorbidities, including pre-clinical conditions.”

A separate study published recently in the Scandinavian Journal of Urology assessed the prevalence and bother of LUTS in 4384 Finnish men aged 30 to 80 years in TAMUS. Overall, the most burdensome LUTS were urgency, post-micturition dribble, nocturia, and incomplete emptying. Urgency and nocturia were more prominent in elderly men aged 70 to 80 years and post-micturition dribble in young men aged 30 to 40 years.

References

Åkerla J, Pesonen JS, Pöyhönen A, et al. Impact of lower urinary tract symptoms on mortality: a 21-year follow-up among middle-aged and elderly Finnish men. Prostate Cancer and Prostatic Diseases. DOI:10.1038/s41391-018-0108-z

Pöyhönen A, Åkerla J, H€akkinenb JT, et al. Severity and bother of lower urinary tract symptoms among men aged 30–80 years: Tampere Ageing Male Urological Study (TAMUS). Scandinavian J Urol. DOI:10.1080/21681805.2018.1505944

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