Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
JU INSIGHT The Reduction of Male Lower Urinary Tract Symptoms Is Associated With a Decreased Risk of Death
By: Blayne Welk, MD, MSc, Western University, London, Ontario, Canada; J. Andrew McClure, MSc, London Health Sciences Center, Ontario, Canada | Posted on: 25 Oct 2023
Welk B, McClure JA. The reduction of male lower urinary tract symptoms is associated with a decreased risk of death. J Urol. 2023;210(4):670-677.
Study Need and Importance
Male urinary symptoms are common and bothersome. Despite this, men generally seek treatment only when symptoms are significantly bothersome. While research has established the negative medical complications associated with male urinary symptoms, the connection between these symptoms and mortality has not been well studied.
What We Found
We used data from the MTOPS (Medical Treatment of Prostate Symptoms) randomized study which had the following arms: placebo, alpha blocker (doxazosin), 5-alpha reductase inhibitor (finasteride), and combination therapy (doxazosin and finasteride). Among the 3,046 men, we found that reducing urinary symptoms (as measured by the AUA Symptom Score) resulted in a statistically significant reduction in the risk of mortality. This effect was quite pronounced: the hazard of death decreased by 12% if the AUA Symptom Score decreased by 3 points. This effect persisted in sensitivity analyses when we censored men at the time of transurethral prostatectomy, adjusted for confounders, and shortened the observation period after the last study visit. Importantly, the reduced risk of mortality was seen with both the storage and the voiding domains independently (see Table). The mechanism of this effect is not clear and may be from direct nonurinary benefits from the medications, or it may represent a causal relationship with untreated urinary symptoms increasing the risk of falls, poor sleep, and impaired mental health.
Table. Exploratory Analysis of the Individual Components of the AUA Symptom Score on the Risk of Death
| Hazard ratio | P value | |
|---|---|---|
| Model 1: Quality-of-life question score change (per 1-point improvement) | 0.84 (0.73-0.95) | < .01 |
| Model 2: Storage symptom score change (per 1-point improvement) | 0.94 (0.88-0.99) | .04 |
| Model 3: Voiding symptom score change (per 1-point improvement) | 0.95 (0.91-0.99) | .03 |
| Model 4: Nocturia score change (per 1-point improvement) | 0.90 (0.76-1.06) | .2 |
| All models were adjusted for age and treatment assignment. A hazard ratio less than 1 indicates a lower risk of death. | ||
Limitations
This is still a historical cohort, and the impact of changes in clinical care and the predominance of newer alpha blockers are not clear. This effect needs to be further studied in other treatment areas for male urinary symptoms (such as overactive bladder medications or procedural interventions) to better understand this relationship.
Interpretation for Patient Care
It is possible that medical interventions for male urinary symptoms may help reduce mortality risk for men.
advertisement
advertisement