Longitudinal Study on Occurrence and Prognosis of Male Lower Urinary Tract Symptoms

Abstract

Lievät virtsaamisoireet ovat yleisiä kaikenikäisillä miehillä. Iän mukana oireet vaikeutuvat, kerääntymisoireet yleistyvät enemmän kuin tyhjennysoireet (esim. virtsantulon viipyminen) tai virtsaamisen jälkeiset oireet (esim. jälkitiputtelu). Yksittäisen oireen vaikeusaste vaihtelee ja oireilla on taipumus parantua itsestään. Virtsavaivat esiintyvät yhdessä ja ne voidaan jakaa tyhjennysoireisiin, kerääntymisoireisiin ja virtsankarkailu-oireisiin. Miehet, joilla virtsaamisoireet ovat hankalia, hyötyvät enemmän leikkaushoidosta kuin lääkehoidosta.

Objectives: The aim of this epidemiological study was to determine the prevalence and burden of lower urinary tract symptoms (LUTS) in male population with an extension to younger cohorts (30 to 50-year-old men). The study was conducted to evaluate the relationship of 12 different LUTS symptoms and assess which symptoms are contingent upon each other. Follow-up studies were used to determine the natural course of LUTS in untreated men and evaluate how well medical and surgical treatments affect different symptoms.

Population and methods: In this population-based study the target population was 30 to 80-year-old men from the Pirkanmaa area, Finland. A self-administered postal questionnaire survey was conducted in 2004. In the two follow-up studies of this dissertation the three oldest age groups from 60 to 80 years were used. Endpoint assessment was based on the 2004 questionnaire and information on determinants was gathered from the questionnaire of 1999. Demographic data were collected and lower urinary tract symptoms were evaluated using the Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire. Overall participation proportion was 59% (4,384 men out of 7,470) in the 2004 questionnaire. In the longitudinal analyses the 1,679 men who responded to both questionnaires were included in the study. In addition to frequently used statistical methods principal component analysis was used to assess how LUTS relate to each other.

Results: LUTS were also common among young (30-year-old) men, as 45% of them experienced urgency and 43% experienced postmicturition dribble. Both prevalence and severity of LUTS increased with age. Storage symptoms especially increased steeply with age. LUTS were classified using principal component analysis to evaluate how symptoms inter-correlated with each other. Three components were formed representing voiding, storage and incontinence symptoms. In five-year follow-up all LUTS fluctuated substantially. Incidence of different LUTS varied from 1% to 13%, with a more than 10-fold difference in incidence. Remission of symptoms was more similar for different symptoms. About half of the symptoms resolved spontaneously in five years. Surgical and medical treatment options for LUTS due to benign prostatic obstruction were compared over a five-year period. Surgical treatment reduced symptoms, while among patients with medical treatment or no treatment LUTS became worse. In individual symptoms, dysuria and postmicturition dribble were the only symptoms with better outcomes for medical than surgical treatment.

Conclusions: Minor LUTS are common in all ages and severe symptoms become more common with age. Storage symptoms increase more than voiding (e.g. hesitancy) and postmicturition symptoms (e.g. postmicturition dribble). LUTS fluctuate and spontaneous recovery is frequent. In terms of correlations between individual symptoms, they could be divided to voiding, storage and incontinence symptoms. Men with severe LUTS benefit more from surgical than medical treatment.