Individual Lower Urinary Tract Symptoms Research Articles

Effects of overactive bladder on treatment-related behaviour and quality of life in an Eastern European country: findings from the LUTS POLAND Study

IntroductionThe aim of this study was to investigate treatment-related behaviour and quality of life of a Polish population that reported symptoms of overactive bladder (OAB) syndrome. The analysis also evaluated the impact of individual lower urinary tract symptoms and their specific bother on treatment seeking, treatment receiving, treatment satisfaction, and treatment continuation, in the same population.Material and methodsThe participants were aged ≥ 40 years with possible diagnosis of OAB based on a score of ≥ 8 on the OAB-V8 questionnaire. Respondents used Likert-like scales to rate the frequency and symptom-specific bother of individual lower urinary tract symptoms. Regression models were constructed to analyse all associations.ResultsOf 6005 participants, 33.9% (n = 2041) had a possible diagnosis of OAB. Almost 40% (n = 810) were seeking treatment, and most participants received treatment (37.7%, n = 770). There was no difference between individuals in urban and rural areas. Prescribed drugs were the most common treatment for OAB symptoms. We did not observe differences in treatment satisfaction or dissatisfaction between men and women, but statistically more men than women continued their treatment. Symptoms of all categories, not only storage, but also voiding, and post-micturition, were associated with a negative effect on an individual’s treatment-related outcome. Finally, OAB had a negative effect on quality of life because 43% (n = 878) of persons with possible OAB had concerns about their quality of life related to their urinary condition.ConclusionsThis study is the first Eastern European population-representative analysis of treatment-related behaviours for OAB. Our study highlights the importance of patient education about the condition and treatment options.

Revisiting the Spectrum of Bladder Health: Relationships Between Lower Urinary Tract Symptoms and Multiple Measures of Well-Being.

Background: Little research to date has investigated the spectrum of bladder health in women, including both bladder function and well-being. Therefore, we expanded our previous baseline analysis of bladder health in the Boston Area Community Health (BACH) Survey to incorporate several additional measures of bladder-related well-being collected at the 5-year follow-up interview, including one developed specifically for women. Methods: At follow-up, participants reported their frequency of 15 lower urinary tract symptoms (LUTS), degree of life impact from and thought related to urinary symptoms or pelvic/bladder pain/discomfort, and perception of their bladder condition. Prevalence ratios were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. The BACH Survey was approved by the New England Research Institutes Institutional Review Board and all participants provided written informed consent. Results: Generally similar findings were observed in the 5-year cross-sectional analysis as at baseline, irrespective of how we categorized LUTS or measured bladder-related well-being. Approximately one in five women (16.2%-18.0% of 2527 eligible women) reported no LUTS and no diminished bladder-related well-being, the majority (55.8%-65.7%) reported some LUTS and/or diminished well-being, and a further one in five (16.9%-26.6%) reported the maximum frequency, number, or degree of LUTS and/or diminished well-being. Measures of storage function (urinating again after <2 hours, perceived frequency, nocturia, incontinence, and urgency) and pain were independently associated with bladder-related well-being. Conclusions: Our similar distribution of bladder health and consistent associations between LUTS and bladder-related well-being across multiple measures of well-being, including a female-specific measure, lend confidence to the concept of a bladder health spectrum and reinforce the bothersome nature of storage dysfunction and pain.

Impact of OAB symptoms on work, quality of life and treatment-seeking behavior in Brazil

Objective: To evaluate the effect of individual lower urinary tract symptoms (LUTS) and LUTS-specific bother on daily/leisure activities, work productivity and treatment behaviors and satisfaction in a Brazilian population reporting symptoms of the overactive bladder (OAB) syndrome.Methods: Secondary analysis of Brazil LUTS study data, including individuals ≥40 years old with a possible diagnosis of OAB, based on a score of ≥8 on the OAB-V8 questionnaire. Participants used a 5-point Likert scale to rate occurrence of LUTS during the previous month. Regression models were constructed to analyze association of symptom frequency and bother, controlled for demographics, comorbid conditions, habits and body mass index, to outcomes related to people’s lives and treatment patterns.Results: This analysis included 5184 individuals (53% female), 24.4% of whom received a possible diagnosis of OAB. There was a greater likelihood of OAB symptoms in men reporting depression/anxiety (2.0 times), diabetes (1.8 times), or constipation (1.9 times) and women reporting depression/anxiety (2.6 times), constipation (1.7 times), and being overweight (1.4 times) or obese (1.8 times). Symptoms of all categories, including voiding, storage, and post-micturition, were associated with a negative impact on individuals’ lives, quality of life and treatment-related outcomes. Treatment seeking for OAB was low among men and women overall (35.1 and 43.6%, respectively), with highest rates among individuals in the 60–69 age group.Conclusions: LUTS of all categories impacted all domains studied. These results highlight the importance of comprehensive LUTS assessment in OAB patients, including voiding, storage and post-micturition symptoms.

Lower urinary tract symptoms and health-related quality of life in Hong Kong primary care: a cross-sectional study.

To estimate the prevalence of lower urinary tract symptoms (LUTS) in primary care using the International Continence Society symptom definition; to evaluate the association between LUTS and health-related quality of life (HRQOL); and to evaluate the treatment gaps. Patients aged 40 and above were randomly recruited in a Hong Kong public primary care. Patients were asked (i) how often they experienced 18 individual LUTS during the past 4weeks and (ii) whether they had sought treatments for their LUTS. The 12-Item Short Form Health Survey version 2 (SF-12 v2) and the modified Incontinence Impact Questionnaire-Short Form (IIQ-7) were used to measure HRQOL. 500 patients completed the survey. 75.8% of the patients had at least one LUTS "at least sometimes", with patients with a combination of storage, voiding, and post-micturition symptoms being the most prevalent (22.2%), followed by a combination of voiding and storage symptoms (14%). Only 14% of LUTS patients had sought treatments for their LUTS. LUTS was associated with a negative effect in all domains of the SF-12 v2 and IIQ-7 and patients with a combination of storage, voiding, and post-micturition symptoms had the worst HRQOL. Finally, having a combination of storage, voiding, and post-micturition symptoms and poorer HRQOL were factors associated with having sought treatments for LUTS. A high prevalence of LUTS but low treatment-seeking rates implied possible unmet needs of LUTS patients in primary care, suggesting the potential for more active interventions to alleviate the negative impact of LUTS on patients' HRQOL.

Prevalence of Urgency in Patients with LUTS Due to BPE

To review recent data on the prevalence and treatment of the symptom of urgency in men with benign prostatic enlargement (BPE). In recent years, researchers have moved to separate out individual lower urinary tract symptoms (LUTS) to see the individual impact. A recent registry trial put the prevalence of urgency at 38% in men with BPE. Other studies have reported urgency present in 64% of men with LUTS. While urgency is not as frequent a complaint in BPE as nocturia and frequency, it does have an impact on health-related quality of life. It is not increased in men with diabetes or the metabolic syndrome. Contributing factors may include prostate inflammation and decreased bladder blood flow from outlet obstruction. While some response is seen with treatment with alpha-blockers, more recently, anticholinergic and beta 3 medications are being used for refractory urgency in men with BPE. Urinary urgency is commonly reported in men with benign prostatic enlargement and is just beginning to be better evaluated with screening tools commonly used in overactive bladder patients. Specific medical therapy for urgency is helping to improve the response rate above traditional BPE therapy.

Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse.

To investigate the prevalence of lower urinary tract symptoms in adolescents and the effects of psychotropic substance use. This was a population-based cross-sectional survey using a validated questionnaire in students from 45 secondary schools in Hong Kong randomly selected over the period of January 2012 to January 2014. A total of 11 938 secondary school students (response rate, 74.6%) completed and returned a questionnaire that was eligible for analysis. Individual lower urinary tract symptoms and history of psychotropic substance abuse were documented. In this study, 11 617 non-substance abusers were regarded as control subjects and 321 (2.7%) were psychotropic substance users. Among the control subjects, 2106 (18.5%) had experienced at least one lower urinary tract symptom with urinary frequency being the most prevalent symptom (10.2%). Females had more daytime urinary incontinence (P<0.001) and males had more voiding symptoms (P=0.01). Prevalence of lower urinary tract symptoms increased with age from 13.9% to 25.8% towards young adulthood and age of ≥18 years (P<0.001). Among the substance users, ketamine was most commonly abused. Substance users had significantly more lower urinary tract symptoms than control subjects (P<0.001). In multivariate analysis, increasing age and psychotropic substance abuse increased the odds for lower urinary tract symptoms. Non-ketamine substance users and ketamine users were respectively 2.8-fold (95% confidence interval, 2.0-3.9) and 6.2-fold (4.1-9.1) more likely than control subjects to develop lower urinary tract symptoms. Females (odds ratio=9.9; 95% confidence interval, 5.4-18.2) were more likely to develop lower urinary tract symptoms than males (4.2; 2.5-7.1) when ketamine was abused. Lower urinary tract symptoms are prevalent in the general adolescent population. It is important to obtain an accurate history regarding psychotropic substance use when treating teenagers with lower urinary tract symptoms.

Lower Urinary Tract Symptoms and Risk of Nonspine Fractures among Older Community Dwelling U.S. Men

Among older men, moderate and severe lower urinary tract symptoms are associated with increased fall risk compared to mild lower urinary tract symptoms. Falls are a major risk factor for fractures. Therefore, we assessed associations of lower urinary tract symptoms with fracture risk in community dwelling U.S. men age 65 years or older. We conducted a prospective study in the MrOS (Osteoporotic Fractures in Men Study) cohort. Men were enrolled at 6 U.S. sites. The AUA-SI, lower urinary tract symptoms medication use, fracture risk factors and potential confounders were recorded at baseline and every 2 years thereafter for 4 assessments. Lower urinary tract symptom severity was categorized from the AUA-SI as mild (0 to 7 points), moderate (8 to 19 points) or severe (20 or more points). Associations of lower urinary tract symptom severity with fracture rate were estimated with HRs and 95% CIs from extended proportional hazards regression. Among 5,989 men with baseline AUA-SI score and hip bone mineral density measures, 745 incident nonspine fractures occurred during 43,807 person-years of followup. In a multivariable model adjusted for age, enrollment site, baseline hip bone mineral density, falls in the last year and prevalent fracture before baseline, there were no significant associations of moderate (HR0.9, 95% CI 0.8-1.1) or severe (HR 1.0, 95% CI 0.8-1.3) lower urinary tract symptoms with fracture risk. None of the individual lower urinary tract symptoms assessed on the AUA-SI, including nocturia and urgency, was associated with increased fracture risk. In this cohort of older U.S. men, lower urinary tract symptoms were not independently associated with fracture risk.

A population-based survey of the prevalence, potential risk factors, and symptom-specific bother of lower urinary tract symptoms in adult Chinese women: a cross-sectional study

BackgroundFew epidemiological studies of lower urinary tract symptoms have been done in China, and none has been done nationwide. Our study aimed to estimate the prevalence and potential risk factors of these symptoms, and the bother they cause in adult women (older than 20 years) in China. MethodsThis is the second analysis of a population-based cross-sectional survey on urinary incontinence done between February and July, 2006, in six regions of China. Cluster samples were randomly selected for interviews. A modified Chinese Bristol Female Lower Urinary Tract Symptoms questionnaire was administered. Participants were asked about the presence of individual symptoms and rated their symptom bother. Descriptive statistics, chi-squared test, receiver operating characteristic curve, and multivariate logistic regressions were used for data analysis. The study was approved by the institutional ethics committee of Peking Union Medical College Hospital, Beijing, China. Findings18 992 (95·0%) of 20 000 respondents were included in this study. 976 (4·9%) of the questionnaires could not be assessed and were excluded in the previous urinary incontinence study; 32 participants were further excluded because of missing information regarding reproductive factors or lower urinary tract symptoms. 10 540 (55·5%) reported at least one lower urinary tract symptom, 10 245 (53·9%) recalled storage symptoms, and 2444 (12·9%) reported voiding symptoms; the prevalence of all these symptoms increased with age. Nocturia was the most common symptom (4450 [23·4%] patients), followed by urgency (4430 [23·3%]) and stress urinary incontinence (3592 [18·9%]). Nocturia was most frequently rated as bothersome (4138 [93·0%]) but was generally minor (3331 [80·5%]). Urgency and urgency urinary incontinence were most frequently reported as severe (315 [11·5%] and 189 [10·8%], respectively) or moderate (508 [18·5%] and 294 [16·8%], respectively) bothers. Lower urinary tract symptoms were more prevalent in women in urban areas than those in rural areas (5420 [57·1%] vs 5210 [53·9%]). Several factors increased the odds of bother and individual lower urinary tract symptoms, and older age and coexisting pelvic organ prolapse were strong predictors (appendix). This survey was done in 2006 and did not assess all lower urinary tract symptoms. InterpretationHalf of adult women have lower urinary tract symptoms, with nocturia, urgency, and stress urinary incontinence being the most prevalent. Urgency and urgency urinary incontinence were most frequently regarded as severe or moderate bothers and should be targeted for medical intervention. FundingThe Chinese Government (5-year national project, number 3053750)

Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms.

ObjectivesTo determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting.Materials and MethodsWe conducted a cross-sectional study of 1021 men aged 40–79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses.ResultsThere were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity.ConclusionSeverity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.

A Population-based Survey of the Prevalence, Potential Risk Factors, and Symptom-specific Bother of Lower Urinary Tract Symptoms in Adult Chinese Women

BackgroundEpidemiological studies of lower urinary tract symptoms (LUTS) are few in China, and none has been conducted nationwide. ObjectiveTo estimate the prevalence and potential risk factors of LUTS and the bother they impose on adult women in China. Design, setting, and participantsThis is the second analysis of a population-based cross-sectional survey on urinary incontinence conducted between February and July 2006 in six regions of China. Cluster samples were randomly selected for interviews. InterventionsNo intervention was implemented. Outcome measurements and statistical analysisA modified Chinese Bristol Female Lower Urinary Tract Symptoms questionnaire was administered. The participants were asked about the presence of individual LUTS and rated their symptom bother. Descriptive statistics, χ2 tests, receiver operating characteristic curves, and multivariate logistic regressions were used for data analysis. Results and limitationsA total of 18 992 respondents (94.96%) were included. The prevalence of any LUTS, storage symptoms, or voiding symptoms was 55.5%, 53.9%, and 12.9%, respectively, and increased with age. Nocturia was the most common symptom (23.4%), followed by urgency (23.3%) and stress urinary incontinence (SUI; 18.9%). Nocturia was most frequently rated as bothersome (93.0%) but was generally minor (80.5%). Urgency and urgency urinary incontinence (UUI) were most frequently reported as severe (11.5% and 10.8%) or moderate (18.5% and 16.8%) bothers. Any LUTS were more prevalent in urban women (57.1% vs 53.9%). Multiple factors increased the odds of bother and individual LUTS, and older age and coexisting pelvic organ prolapse were strong predictors (p<0.05). This survey was conducted 8 yr ago and did not assess all LUTS. ConclusionsHalf of adult women suffered with LUTS; nocturia, urgency, and SUI were more prevalent. Urgency and UUI were most frequently reported as severe or moderate bothers. Multiple factors influenced bother and individual LUTS. Patient summaryThe prevalence of lower urinary tract symptoms is high and increases with age in adult women in China. Urgency and urgency urinary incontinence were most frequently regarded as severe or moderate bothers and should be targeted for medical intervention.

Associations between individual lower urinary tract symptoms and bacteriuria in random urine samples in women

Previous studies have noted an association between a diagnosis of overactive bladder and bacteriuria, but little is understood about the relationship of bacteriuria to specific LUTS. We hypothesized that bacteriuria in women would be associated with increased self-reported symptom scores for a wide range of LUTS. Women were recruited from general gynecology and urogynecology outpatient clinics in a secondary care setting. Women completed the 12-item International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms and provided a clean-catch mid-stream specimen of urine for microscopy and culture. Women with acute urinary tract infection were excluded. Three statistical approaches (Mann-Whitney U-test, multivariable logistic regression, and receiver operating characteristic curves) were used to assess differences in symptom scores between women with and without bacteriuria. Two hundred forty-seven women were recruited, aged 22-82. Sixteen of 247 urine samples (6.5%) demonstrated significant bacteriuria, growing a different range of organisms. Women with significant bacteriuria were more likely to have nocturia (OR 3.56, 95% CI 1.19-10.6, P = 0.02), urgency (OR 6.66, 95% CI 1.47-30.06, P = 0.01), bladder pain (OR 2.82, 95% CI 1-7.92, P = 0.049), urgency incontinence (OR 2.92, 95% CI 1.02-8.36, P = 0.046), nocturnal enuresis (OR 4.21, 95% CI 1.32-13.41, P = 0.01). After adjustment for age, parity, symptomatic prolapse, menopausal status and history of mid-urethral sling urinary urgency, bladder pain, nocturia, and nocturnal enuresis remained significantly associated. Bacteriuria is associated with a range of LUTS including nocturia, urgency, and bladder pain supporting a role for bacterial colonization in the pathogenesis of OAB symptoms.

Treatment satisfaction with low-dose tamsulosin for symptomatic benign prostatic hyperplasia: results from a multicentre cross-sectional survey

To evaluate the efficacy and treatment satisfaction with low-dose (0.2 mg) tamsulosin in patients with symptomatic benign prostatic hyperplasia (BPH), and to investigate individual lower urinary tract symptoms according to treatment satisfaction. A cross-sectional study was conducted in a total sample of 2574 patients from multiple centres. International Prostate Symptom Score (IPSS), prostate volume, uroflowmetry and combined medications were reviewed. Detailed questionnaires were used to assess treatment satisfaction and IPSS 8 weeks after treatment with low-dose tamsulosin. After 8 weeks of treatment with low-dose tamsulosin, IPSS improved significantly. Among the 2574 patients, 1,630 (63.42%) were satisfied and 940 patients (36.50%) were dissatisfied with low-dose tamsulosin. The reasons for dissatisfaction included efficacy problems (84.66%) and side effects (3.72%). Treatment satisfaction was affected by symptom duration, baseline IPSS, and prostate size (p = 0.0441, < 0.001, < 0.009, respectively). IPSS voiding (IPSS-V) and IPSS storage (IPSS-S) after treatment differed significantly depending on the degree of satisfaction (p < 0.001). IPSS-V after treatment did not improve in patients who were 'not satisfied' or 'totally not satisfied' (p = 0.170, 0.240, respectively). All the individual IPSS items except urgency (p = 0.1436) varied significantly with the degree of satisfaction (p < 0.001). Treating symptomatic BPH with low-dose tamsulosin improved IPSS, but more than one-third of patients were dissatisfied with the treatment. The main reason for dissatisfaction was efficacy problems, and the degree of satisfaction was related to symptom duration, baseline IPSS, and prostate size, and also to IPSS-V. In patients with severe LUTS, the tamsulosin dose should be increased earlier.

National Community Prevalence of Overactive Bladder in the United States Stratified by Sex and Age

To estimate the prevalence of and bother associated with overactive bladder (OAB) in adults aged ≥40 years in the United States, using current International Continence Society definitions. Internet-based panel members were selected randomly to participate in EpiLUTS, a cross-sectional, population-representative survey. Participants used Likert scales to rate how often they experienced individual lower urinary tract symptoms during the previous 4 weeks and how much bother they experienced. Based on responses to questions regarding urgency and urgency urinary incontinence, OAB symptoms were categorized as occurring at least "sometimes" or at least "often." Symptom bother was categorized as at least "somewhat" or at least "quite a bit." The response rate was 59.6%, with a final sample of 9416 men and 10,584 women. Prevalence of OAB symptoms at least "sometimes" was 27.2% and 43.1% for men and women, respectively; prevalence of OAB at least "often" was 15.8% and 32.6%, respectively. Among men with OAB symptoms at least "sometimes," 60.0% were bothered at least "somewhat" and 27.8% were bothered at least "quite a bit." Among women, bother rates were 67.6% and 38.9%, respectively. Among respondents with OAB at least "often," 67.8% and 38.2% of men and 73.0% and 47.1% of women reported being bothered at least "somewhat" and at least "quite a bit," respectively. We estimate that 29.8 million adults aged ≥40 years in the United States have bothersome OAB symptoms. Bothersome OAB symptoms are highly prevalent among men and women aged ≥40 years in the United States.

Using the ICSQoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS–‘BPH’ study

To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF-36 and the EuroQol. ICSQoL items may be used individually or as a group in research studies or in clinical practice.