Background: The usefulness of lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. Repeated assessments are required to take into account symptom fluctuation and de novo symptom appearance. The study objective was to evaluate mortality in relation to three urinary storage symptoms-urgency, daytime frequency and nocturia-in middle-aged and elderly men, considering also other time-varying factors during follow-up. Methods: A mail survey of a population-based cohort of men initially aged 50, 60 and 70 years was conducted in Finland in 1994, 1999, 2004 and 2009. The questionnaire included assessments of LUTS based on the Danish Prostatic Symptom Score and comorbidities. The men were followed up for mortality through the population registry through 2014. LUTS-related hazard ratios (HR) were analyzed with timedependent Cox regression adjusted for the year of birth and comorbidities using variable values updated every five years. Sensitivity analyses were conducted using values of all variables fixed to the baseline assessment of 1994. Results: Of the 1332 eligible men with data on LUTS from each preceding survey, 514 (38.6%) died during the 21-year follow-up. In time-dependent analyses, daytime frequency and nocturia were significantly associated with increased mortality: the adjusted HR was 1.42 (95%CI 1.11-1.83) for daytime frequency, 1.38 (1.07-1.79) for nocturia and 1.19 (0.94-1.50) for urgency. In sensitivity analyses with fixed baseline characteristics, only nocturia was suggestively associated with an increased risk of death: the adjusted HR was 1.09 (0.84-1.42) for daytime frequency, 1.41 (0.99-2.02) for nocturia and 0.94 (0.52-1.68) for urgency. Conclusions: Among aging men, LUTS are more accurate predictors of short-term than longer-term mortality risk. Repeated assessments are needed to detect clinically 3 ill health. Accordingly, men relevant and persistent symptoms, often associated with with daytime frequency or nocturia exhibit a 1.4-fold risk of death and therefore, should be evaluated for underlying comorbidity.

The prevalence of the postmicturition dribble was found to be high in this survey. Half of the 30-year-old men and two-thirds of the men aged 60-80 years had postmicturition dribble. Dribbling into trousers increased with age but as a severe symptom, it was rare (0.5%). Minor problems from postmicturition dribble were common, but major bother occurred seldom (1.1%).

Purpose:The utility of male lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. We explored LUTS-associated mortality among Finnish men, evaluating the association of symptom severity and bother with risk of death.Materials and Methods:A questionnaire including the Danish Prostatic Symptom Score was mailed to a population-based cohort of 3,143 men aged 50, 60 and 70 years in 1994, with repeat surveys in 1999, 2004, 2009 and 2015. The men were followed until the end of 2018. 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.Results:Of the 1,167 men in the analysis, 591 (50.6%) died during the 24-year followup. In analyses of moderate and severe symptoms disregarding bother, overall voiding and storage LUTS, daytime frequency and urgency incontinence were associated with increased mortality: the multivariable-adjusted hazard ratios were 1.19 (95% CI 1.00–1.40), 1.35 (1.13–1.62), 1.31 (1.09–1.58) and 2.19 (1.42–3.37), respectively. In analyses disregarding symptom severity and bother, voiding LUTS were associated with decreased mortality, while daytime frequency and nocturia were associated with increased mortality: the HRs were 0.82 (95% CI 0.67–1.00), 1.31 (95% CI 1.09–1.58) and 1.52 (95% CI 1.21–1.91), respectively. Excess mortality associated with bothersome daytime frequency and nocturia tended to be slightly higher: the HRs were 1.86 (95% CI 1.41–2.47) and 1.88 (95% CI 1.38–2.58), respectively. No significant interactions were found between symptoms and associated bother, however.Conclusions:Moderate and severe LUTS are potential risk factors for mortality, independently of their bother.

No abstract

What ' s known on the subject? and What does the study add? In several population-based studies the prevalence of hesitancy has varied from 20% to 52%. Studies concern mostly older men ≥ 50-years-old. Knowledge of troublesomeness that hesitancy causes is very scarce. This is a large population-based study on hesitancy in men with a wide age range. This study reports the prevalence of hesitancy from 30-year-old men to 80-year-old men. The bother of hesitancy is reported and this is also presented in different age groups. OBJECTIVE• To estimate the prevalence and bother of hesitancy by age group. MATERIALS AND METHODS• In this population-based study, the target population was 30-to 80-year-old men from Pirkanmaa County, Finland.• Information was collected by means of a mailed self-administered questionnaire in 2004. The overall participation proportion was 58.7% (4384 men out of 7470).• The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire was used to evaluate urinary symptoms, particularly hesitancy. Logistic regression was used for multivariate analysis. RESULTS• Almost half of the men (46.8%, 95% CI 45.3 -48.3%) reported hesitancy at least occasionally, but only 0.5% (95% CI 0.3 -0.7%) had hesitancy every time they urinated. The prevalence of any hesitancy was 42.3% at 30 years and 50.5% at 80 years of age (trend P < 0.001). Only a few men reported hesitancy often or always, prevalence increasing with age from 2.6% to 11.4% (trend P < 0.001).• Hesitancy caused a small problem for 18.3% of the men and a moderate or major problem for 0.9 -5.3%. Only 3% of the men with infrequent hesitancy reported more than a small problem, whereas 59% of the men with hesitancy often or always reported a small problem and 32% reported a moderate or major problem.• Two other voiding symptoms, straining and weak stream, were strongly associated with hesitancy (with odds ratios exceeding 80). CONCLUSIONS• Mild hesitancy is very common in men of all ages.• Severe cases are rare, but the prevalence increases with age.• Hesitancy is a well-tolerated urinary symptom. KEYWORDSepidemiology , hesitancy , prevalence , urinary tract physiological processes Study Type -Therapy (symptom prevalence) Level of Evidence 2a