Moderate/severe male LUTS linked to increased risk of death

Moderate and severe lower urinary tract symptoms (LUTS), independent of their bother, can potentially increase the risk of death in men, according to findings from a population-based cohort study among Finnish men published in the Journal of Urology.¹

The analysis, which included over 1000 Finnish men, showed that when disregarding bother, moderate/severe voiding LUTS were associated with a 1.19-fold increased risk of death and moderate/severe storage LUTS were associated with a 1.35-fold increased risk of death. When including patients with mild symptoms in the analysis, the mortality risks were reduced to 0.8-fold and 0.9-fold among men with any voiding or storage LUTS, respectively.

The researchers also found that moderate/severe daytime frequency and urgency incontinence were associated with a 1.31-fold and 2.19-fold increased risk of death, respectively.

A separate assessment in which both symptom severity and bother were disregarded showed that the risk of death was increased by 1.31-fold in men with daytime frequency and 1.52-fold in men with nocturia. In this analysis, however, voiding LUTS were actually linked to a 0.82-fold decrease in mortality risk.

“For clinicians, the analyses show that moderate and severe male LUTS in general are good indicators of poor health, whereas mild LUTS can be considered as a normal part of healthy aging with an exception in cases of persistent daytime frequency and nocturia,” the authors wrote.

The investigators initiated this population-based cohort study in 1994, when they mailed a questionnaire to men they identified in the Finnish Population Register who were aged 50, 60, and 70 years at the time. The questionnaire included the Danish Prostatic Symptom Score (DAN-PSS-1) to assess LUTS in these men. The investigators repeated the assessments in 1999, 2004, 2009, and 2015.

The men in the study were followed until the end of 2018. According to the investigators, “Mortality associated with LUTS was analyzed using time-dependent Cox regression adjusted for age and comorbidity, updating symptom data every 5 years, including interaction terms between symptoms and associated bother.”

The final analysis included 1167 men, of whom 591 (50.6%) died during the 24-year follow-up.

“While the association between LUTS and mortality is largely explained by the comorbidities in men with LUTS, the fact that the association remained even after adjustment for age and comorbidity shows that other, currently unidentified factors increasing the risk of death are also involved,” the investigators wrote in their concluding remarks. “Furthermore, although increased bother and impaired coping skills may be associated with issues in symptomatic men’s general health, mortality did not significantly differ between men with bothersome and non-bothersome LUTS.”

Reference

1. 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 Jun;207(6):1285-1294. doi: 10.1097/JU.0000000000002450