Urinary Symptoms Linked to Increased Mortality Risk in Men

Moderate and severe lower urinary tract symptoms (LUTS) may be risk factors for mortality in men, according to a Finnish population-based cohort study.

In multivariable-adjusted analyses of moderate and severe symptoms (disregarding bother), voiding and storage LUTS were each associated with increased mortality (HR 1.19, 95% CI 1.00-1.40, and HR 1.35, 95% CI 1.13-1.62, respectively), reported Jonne Åkerla, MD, of Tampere University Hospital in Finland, and colleagues.

However, in multivariable-adjusted analyses disregarding symptom severity and bother, both voiding and storage LUTS were associated with decreased mortality (HR 0.82, 95% CI 0.67-1.00, and HR 0.85, 95% CI 0.65-1.13), while daytime frequency and nocturia were associated with increased mortality (HR 1.31, 95% CI 1.09-1.58, and HR 1.52, 95% CI 1.21-1.91, respectively).

Of the 1,167 men included in the analysis, 50.6% died over the course of 24-year follow-up, the team noted in the Journal of Urology.

“[T]he associations between LUTS and mortality should be generally considered as proxies of ill health,” the authors wrote. “This indicates the importance of assessing the general health, risk factors, and major comorbidities among men with LUTS.”

When mild symptoms were also included in the analysis, the mortality risk was reduced to 0.8-fold in those with any voiding LUTS and to 0.9-fold in those with storage LUTS. On the other hand, there was a 1.3-fold increased risk of death with daytime urinary frequency and a 1.5-fold increased risk with nocturia, independent of symptom severity.

“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,” Åkerla and colleagues wrote.

In age-adjusted analyses of moderate and severe LUTS disregarding bother, both voiding and storage LUTS were associated with increased mortality (HR 1.28, 95% CI 1.09-1.51, and HR 1.62, 95% CI 1.36-1.93, respectively), while in age-adjusted analyses of moderate and severe urgency and urgency incontinence disregarding bother, urgency alone suggested a small association with increased mortality (HR 1.27, 95% CI 0.99-1.64).

Of note, urgency incontinence showed a particularly strong association (HR 2.15, 95% CI 1.41-3.26), which remained undiminished (HR 2.19, 95% CI 1.42-3.37) in multivariable-adjusted analysis.

This strong association between urgency incontinence and mortality “suggests the significance of urinary urgency in late life morbidity and frailty including factors such as white matter hyperintensity load and microvascular disease,” Åkerla and colleagues wrote.

For this study 3,143 men (ages 50, 60, and 70 at the time of study launch in 1994) were mailed questionnaires that included items on severity and bother of LUTS; sociodemographic and behavioral factors; and medical conditions. Assessments were repeated every 5 years up to 2015. The men were followed until the end of 2018.

About half of the men had received medical or surgical treatment for benign prostatic hyperplasia/LUTS. Those with more severe LUTS were generally older than those with moderate LUTS, and were more likely to have comorbidities, including diabetes, hypertension, cardiac disease, pulmonary disease, cerebrovascular disease, neurological disorders, and malignancies.