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JU INSIGHT: Lower Urinary Tract Symptoms and Mortality among Finnish Men: The Roles of Symptom Severity and Bother
By: Jonne Åkerla, MD; Jori S. Pesonen, MD, PhD; Antti Pöyhönen, MD, PhD; Juha Koskimäki, MD, PhD; Jukka Häkkinen, MD, PhD; Heini Huhtala, MSc; Anssi Auvinen, MD; Teuvo L.J. Tammela, MD | Posted on: 01 Jun 2022
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 2022; 207: 1285.
Study Need and Importance
Due to very uncertain cause-and-effect relationships and the confounding effects of aging and comorbidity, the relevance of male lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. While traditionally only more severe and bothersome LUTS have been considered to require treatment, evaluating the potentially modifying effect of symptom severity and bother on LUTS-associated mortality is warranted.
What We Found
Table. The association of voiding and storage LUTS with mortality by symptom severity and bother
| Severity | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Voiding | Storage | ||||||||
| Anya | Mod/sevb | Anyc | Mod/sevd | ||||||
| HR | 95% CI | HR | 95% CI | HR | 95% CI | HR | 95% CI | ||
| Adjusted by age and comorbiditye | |||||||||
| Bother | No/mild | 0.81 | 0.65–0.99 | 1.22 | 1.01–1.48 | 0.80 | 0.60–1.06 | 1.20 | 0.92–1.56 |
| No/any | 0.82 | 0.67–1.00 | 1.19 | 1.00–1.40 | 0.85 | 0.65–1.13 | 1.35 | 1.13–1.62 | |
| Moderate/severe | 0.88 | 0.67–1.16 | 1.12 | 0.88–1.43 | 1.10 | 0.80–1.50 | 1.46 | 1.18–1.81 | |
aAny voiding or post-voiding symptom of at least mild severity, bany voiding or post-voiding symptom of at least moderate severity, cany storage symptom of at least mild severity, dany storage symptom of at least moderate severity, eCox regression for mortality in presence vs. in absence of symptoms by symptom-specific bother, adjusted by age, body mass index, marital status, smoking, diabetes, hypertension, cardiac disease, pulmonary disease, cerebrovascular disease, neurological disease and cancer.
A questionnaire including the Danish Prostatic Symptom Score was mailed to a population-based cohort of 3,143 men aged 50, 60 and 70 years in 1994, with repeat surveys in 1999, 2004, 2009 and 2015. In time-dependent Cox regression adjusted by age and comorbidity, we found a 1.2-fold increased risk of death among men with moderate or severe voiding LUTS and a 1.4-fold risk among men with storage LUTS (see Table). When including also mild symptoms, the mortality risk was reduced to 0.8-fold among men with any voiding LUTS and to 0.9-fold among men with storage LUTS. However, our findings showed a 1.3-fold increased risk of death among men with daytime frequency and a 1.5-fold risk among men with nocturia independently of symptom severity. Furthermore, we found a substantially 2.2-fold increased risk of death among men with frequent urgency incontinence. Mortality did not significantly differ between men with bothersome and nonbothersome LUTS.
Limitations
Despite satisfactory response rates varying from 66% to 76% between survey rounds, the proportion of eligible participants was reduced to 37% (1,167 men) due to eligibility criteria restricting the analyses to men participating in every survey round.
Interpretation for Patient Care
Moderate and severe male LUTS are potential risk factors for mortality, independently of their bother.