Prevalence of conditions potentially associated with lower urinary tract symptoms in men

Abstract

Authors from the Mayo Clinic, using data from the Olmsted County study, estimated the frequency of other causes (other than BPH) of LUTS. They found that such other conditions are prevalent, and increase in frequency with age. They concluded that overlooking these conditions can result in misclassification, misdiagnosis and incorrect treatment. Continuing with the epidemiological theme, authors from the USA attempt to define the normal ranges of the IPSS in a sample of young, asymptomatic men. They conclude that studies of normal urinary habits are important in understanding normal and abnormal function, in the design of research studies and in the counselling of patients. In a further study, authors from the UK describe the incidence, prevalence and management of LUTS reported to UK general practices. The results of this important study are interesting and informative. OBJECTIVE To estimate the frequency of conditions associated with lower urinary tract symptoms (LUTS, typically included when assessing benign prostatic hyperplasia, BPH), as other causes of LUTS should be excluded when diagnosing BPH, using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. SUBJECTS AND METHODS During 1989–91, Caucasian men aged 40–79 years were randomly selected from the Olmsted County population. Before contact, eligibility was determined by reviewing the community medical records. Baseline exclusion criteria included comorbid pre‐existing conditions or treatments, e.g. prostate, bladder or lower back surgery, bladder neck contracture or cancer, diabetes with lower extremity amputation, and neurological diseases, including Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, tabes dorsalis and stroke. Men with these conditions were excluded from the Olmsted County Study at baseline, because these conditions are potentially associated with LUTS. RESULTS Of the 5100 randomly sampled men, 13.4% met at least one of the pre‐existing exclusion criteria. Individually, the frequency of exclusions was 7.8% for prostate cancer or surgery, 4.8% for back surgery, 1.3% for bladder surgery and 1.4% for neurological conditions. All other conditions represented <1.0% of the study exclusions. Older men were more likely to meet at least one of the exclusion criteria, with men in their fifth to eighth decade having a total exclusion frequency of 1.4%, 5.4%, 8.5% and 32.8%, respectively. The most common reason for men in their fifth decade to be excluded was lower back surgery (0.9%), whereas the most common reason in the eighth was prostate surgery (21.8%). CONCLUSIONS In men, conditions that may contribute to LUTS, other than BPH, are prevalent in the community and increase in frequency with age. It is important that other conditions associated with LUTS be excluded before a definitive diagnosis of BPH. Any oversight in this initial evaluation can potentially result in misclassification bias, misdiagnosis and incorrect treatment of patients.