Potential dual benefits to tackling LUTS progression risk factors

Research shows that several risk factors associated with Type 2 diabetes and cardiovascular disease also predict the progression of storage and voiding lower urinary tract symptoms (LUTS) in men, suggesting that targeting these could have multiple benefits.

Gary Wittert (University of Adelaide, South Australia) and colleagues analyzed data from a population-based study on 780 randomly selected men who were initially assessed between 2002 and 2005 and were followed-up 5 years later.

Mild LUTS, as assessed by the American Urological Association symptom index, were reported in 81.9% of men at baseline and 74.5% at follow-up, with the proportion of men reporting moderate and severe symptoms increasing from 15.6% to 22.7%, and from 2.5% to 5.3%, respectively. The percentage of men reporting significant storage and voiding LUTS also increased over time from 27.5% to 34.6% and from 13.1% to 17.7%, respectively.

The team found that storage symptoms remained stable in 27.0% of men over time, improved in 33.1%, and progressed in 39.8%. The respective rates for voiding symptoms were 44.0%, 23.4%, and 32.3%.

Baseline predictors for progression of storage LUTS were high abdominal fat mass, low income, and a diagnosis of depression. Similarly, for voiding LUTS, low income, low plasma high-density lipoprotein (HDL) cholesterol, high estradiol, a diagnosis of depression, and erectile dysfunction at baseline were associated with progression.

By contrast, men who were more active at baseline, and those who reported greater symptom bother were more likely to see improvements. And improvements in storage LUTS, specifically, were associated with high income, high HDL cholesterol, low triglyceride levels, and obstructive sleep apnea risk.

Noting that several of these factors are potentially modifiable, Wittert and team comment that their identification “is significant because of the previous demonstration of improvement in LUTS with diet induced weight loss, treatment of [obstructive sleep apnea] by continuous positive airway pressure and increased physical activity.”

Writing in the Journal of Urology, they add: “[A]ttention should be paid to addressing remediable factors instead of or as an adjunct to specific pharmacotherapy or surgery, not only because of the benefit for the symptoms but also because of the potential to reduce overall cardiometabolic risk.”

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