Progression of Lower Urinary Tract Symptoms in Older Men: A Community Based Study

Purpose

Lower urinary tract symptom progression in community dwelling older men is not well described.

Materials and Methods

We evaluated 5,697 participants in Osteoporotic Fractures in Men, a prospective cohort study of community dwelling men 65 years old or older. We characterized lower urinary tract symptoms using the American Urological Association symptom index at 2 time points, including at study entry and at 2-year followup. Progression was examined in the overall cohort and within baseline symptom strata (symptom index 7 or less and 8 or greater) using descriptive statistics.

Results

At baseline mean ± SD age was 73.5 ± 5.8 years and mean symptom index score was 8.3 ± 6.3 points. Mean and median total symptom index increased during followup by 1.1 ± 5.0 and 1.0 points, respectively. Of the 3,092 men with a symptom index of 7 points or less at baseline 883 (29%) reported lower urinary tract symptoms progression (8 points or greater) at followup. The incidence of lower urinary tract symptom progression increased with advancing baseline age. Of the 2,605 men with a symptom index of 8 points or greater at baseline 622 (24%) reported progression of at least 4 points at followup. Of the 2,200 men with a baseline symptom index of 7 points or less and no history of benign prostatic hyperplasia or lower urinary tract symptom treatment 94% remained untreated, 2% reported benign prostatic hyperplasia surgery and 4% reported medication use at followup.

Conclusions

Up to 29% of community dwelling older men with no or mild lower urinary tract symptoms will have clinically significant lower urinary tract symptoms within 2 years. These data help elucidate the natural history of lower urinary tract symptoms in the community and provide useful data to design clinical trials of lower urinary tract symptom prevention.

Key Words: prostate, urination disorders, prostatic hyperplasia, risk, epidemiology

Abbreviations and Acronyms: AUA-SI, American Urological Association symptom index, BPH, benign prostatic hyperplasia, LUTS, lower urinary tract symptoms, MrOS, Osteoporotic Fractures in Men