Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men

Abstract

BackgroundKnowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission.MethodsIn community dwelling U.S. men age ≥ 65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000–2002) and then every two years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or benign prostatic hyperplasia (BPH) during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modeling of the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared to stable trajectories, and with remitting compared to progressing trajectories. Lifestyle, body mass index (BMI) (kg/m2), mobility, mental health (Short-Form 12), medical history, and prescription medications were considered for selection. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for variables in each model.ResultsWe identified 10 AUA-SI trajectories: four stable (1 277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%), and one mixed (20 men, 1%). Men in progressing compared to stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0–3.8), poor mental health (OR=1.9, 95% CI: 1.1–3.4), BMI ≥ 25.0 kg/m2 (OR=1.7, 95% CI: 1.0–2.8), hypertension (OR=1.5, 95% CI: 1.0–2.4), and back pain (OR=1.5, 95% CI: 1.0–2.4). Men in remitting compared to progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1–4.9) and less often had a history of problem drinking (OR=0.4. 95% CI: 0.2–0.9).ConclusionsSeveral non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.

Lifestyle and lower urinary tract symptoms

“…[16] In addition, being overweight was associated with a significantly higher risk for symptomatic progression based on the IPSS in a prospective study of 1740 elderly men ≥65 years old. [17] A separate study found that a greater abdominal fat mass predicted the progression of LUTS symptoms in a population based cohort of 780 men. [11] Finally, obesity also predicts a poorer response to standard therapies for LUTS.…”

Dietary Antioxidants and Longitudinal Changes in Lower Urinary Tract Symptoms in Elderly Men: The Osteoporotic Fractures in Men Study

“…During follow-up, the cohort for trajectory analysis was further restricted to 1740 men who remained free from diagnosed prostate cancer, reported no surgery or medication use for LUTS, and completed all four AUA-SI assessments. A figure demonstrating how the analytic cohort was ascertained for the trajectory analysis has been previously published [26]. The same study demonstrated no significant differences in LUTS trajectory among men with a history of stroke and those who used CNS medications [26], so we did not exclude them from the present analysis.…”

“…A figure demonstrating how the analytic cohort was ascertained for the trajectory analysis has been previously published [26]. The same study demonstrated no significant differences in LUTS trajectory among men with a history of stroke and those who used CNS medications [26], so we did not exclude them from the present analysis.…”

“…Details of the trajectory method were reported previously [26]. In brief, group-based trajectory modeling was performed using the AUA-SI data from all four time points.…”

“…The four trajectory types identified were stable ( n = 1277), progressing ( n = 345), and remitting ( n = 98) LUTS groups, and one very small group ( n = 20) in which the LUTS trajectory increased and then decreased during follow-up. We identified three LUTS progression trajectories during follow-up: men who progressed from mild to moderate LUTS; men who progressed from moderate to severe LUTS; and men who progressed from low-moderate to high-moderate LUTS [26]. …”