Abstract
BackgroundNo study has compared the bothersomeness of all lower urinary tract symptoms (LUTS) using a population-based sample of adults. Despite this lack of evidence, investigators have often cited their LUTS of interest as the “most bothersome” or “one of the most bothersome.” ObjectiveTo compare the population- and individual-level burden of LUTS in men and women. Design, setting, and participantsIn this population-based cross-sectional study, questionnaires were mailed to 6000 individuals (18–79 yr of age) randomly identified from the Finnish Population Register. Outcome measurements and statistical analysisThe validated Danish Prostatic Symptom Score questionnaire was used for assessment of bother of 12 different LUTS. The age-standardized prevalence of at least moderate bother was calculated for each symptom (population-level burden). Among symptomatic individuals, the proportion of affected individuals with at least moderate bother was calculated for each symptom (individual-level bother). Results and limitationsA total of 3727 individuals (62.4%) participated (53.7% female). The LUTS with the greatest population-level burden were urgency (7.9% with at least moderate bother), stress urinary incontinence (SUI) (6.5%), nocturia (6.0%), postmicturition dribble (5.8%), and urgency urinary incontinence (UUI) (5.0%). Burden from incontinence symptoms was higher in women than men, and the opposite was true for voiding and postmicturition symptoms. At the individual level, UUI was the most bothersome for both genders. Although the response proportion was high, approximately a third did not participate. ConclusionsBoth men and women with UUI report moderate or major bother more frequently than individuals with other LUTS. At the population level, the most prevalent bothersome symptoms are urgency, SUI, and nocturia. Patient summaryUrinary urgency was the most common troubling symptom in a large population-based study; however, for individuals, urgency incontinence was the most likely to be rated as bothersome.
Highlights
Lower urinary tract symptoms (LUTS) are divided into three groups: storage symptoms, voiding symptoms, and postmicturition symptoms [1]
Outcome measurements and statistical analysis: The validated Danish Prostatic Symptom Score questionnaire was used for assessment of bother of 12 different LUTS
The population prevalence of bothersome stress urinary incontinence (SUI) was higher in women (12.0%; 95% confidence intervals (CIs), 10.0–13.9) than in men (0.8%; 95% CI, 0.3–1.3) (Fig. 2; Supplemental Table 2)
Summary
Lower urinary tract symptoms (LUTS) are divided into three groups: storage symptoms (daytime urinary frequency, nocturia, urinary urgency, and urinary incontinence), voiding symptoms (slow stream, splitting or spraying, intermittent stream, hesitancy, straining, and terminal dribble), and postmicturition symptoms (feeling of incomplete emptying and postmicturition dribble) [1]. These symptoms have a major impact on health-related quality of life [2] and are associated with substantial personal and societal expenditures [3]. Patient summary: Urinary urgency was the most common troubling symptom in a large population-based study; for individuals, urgency incontinence was the most likely to be rated as bothersome
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