An investigation of lower urinary tract symptoms as the outcome of factors beyond just an enlarged prostate

ObjectivesThe focus of lower urinary tract symptoms (LUTS) assessment has been predominantly on the urinary system, and the attention of LUTS management has mostly been on prostate-related measures. However, emerging evidence has suggested that the pathology of LUTS extends across different systems. Therefore, a series of studies was performed to improve our current understanding of LUTS, and to investigate the possibilities of optimizing the outcome of LUTS interventions.Materials and MethodsA telephone survey of 1000 subjects above the age of 40 years old including both men and women was performed to investigate the prevalence of LUTS in an Asian population. In order to assess LUTS as a cross-system clinical entity, cardiovascular risk factors as reflected by Framingham risk score were correlated with LUTS in 966 male patients in a cross-sectional study. Disease knowledge as a potential influence in another dimension on disease symptoms and their perception was investigated in 319 community-dwelling subjects. It was carried out by means of the correlation between International Prostate Symptom Score (IPSS) and a prostate disease knowledge quiz. Specific conditions of LUTS as a result of substance abuse and female bladder outlet obstruction (BOO) were studied in order to evaluate the outcome of LUTS interventions. A cross-sectional study in a prospective cohort of 318 patients with ketamine abuse was executed to explore the symptomatology, and to assess the outcome of a 4-tier treatment protocol, namely anti-inflammatory or anti-cholinergic drugs, opioid analgesics or pregabalin, intravesical hyaluronic acid, and surgical intervention. Furthermore, a retrospective review of 20 female patients with BOO having undergone urethral calibration was performed, including pre- and post-treatment urodynamic parameters.ResultsA LUTS prevalence of 77.4% was found in the survey, with mean symptom score higher in men than in women (men, 3.62 ± 4.86; women, 2.56 ± 3.34; p=0.002). Any experience of urgency was 19.5% for men and 19.1% for women, and clinically significant overactive bladder symptoms are 8.6% in men and 5.3% in women. Severity of LUTS was found to be correlated with Framingham risk score in multinomial logistic regression after adjusting for prostate volume using prostate specific antigen (PSA) as a surrogate (OR = 1.033, p=0.008). When individual components of LUTS were looked into, Framingham risk score was found to correlate with storage symptoms (r=0.083; p