The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study

Abstract

The topics covered in this section relate to areas of considerable interest for urologists everywhere. The UrEpik study is introduced in the ‘Comments’ section and the results of the study will appear in a series of papers published over the next few months. They will give a new insight into many aspects of LUTS. Authors from London investigate the place of urodynamics in the evaluation of patients with symptoms of overactive bladder. They found that patients with such symptoms and with apparently normal urodynamic findings often respond equally well to antimuscarinic therapy as do those with positive urodynamic findings. They indicate that these findings cast doubt on the value of urodynamics in such patients before treatment. Authors from North America address the problem of mixed urinary incontinence. They examined the efficacy of tolterodine in patients with this condition and compared it with patients having urge incontinence alone. They found that it was equally effective in reducing leakage and other symptoms of overactive bladder in patients with mixed incontinence as in urge incontinence alone. OBJECTIVE To evaluate the epidemiology of lower urinary tract symptoms (LUTS) among men and women, as there are significant unanswered questions about the prevalence and impact of LUTS in different populations. SUBJECTS AND METHODS A population‐based, cross‐sectional survey was completed in Boxmeer (the Netherlands), Auxerre (France), Birmingham (UK) and Seoul (Republic of Korea), using culturally and linguistically validated versions of the International Prostate Symptom Score (IPSS). The aim was to estimate the distribution of symptoms of LUTS in men and women. Stratified random samples of men aged 40–79 years in each community were collected. Postal questionnaires were used in Europe and direct interviews in Korea. RESULTS In all, 4979 index men and 3790 women were recruited, with age‐adjusted response rates among men of 72% in Boxmeer, 28% in Auxerre, 60% in Birmingham and 68% in Seoul. The percentages of men and women with an IPSS of 8–35, indicating moderate to severe symptoms, were, respectively, 20.7 and 18.0 (Boxmeer); 19.2 and 12.6 (Auxerre); 25.1 and 23.7 (Birmingham); 16.2 and 19.9 (Seoul). Among women the relationship between symptoms and age was not as strong as in men. The percentages of men and women with moderate to severe symptoms were by age group, respectively, 10.6, 15.5 (40–49); 19.0, 18.2 (50–59); 30.5, 23.8 (60–69); 40.4, 28.7 (70–79). Among those aged 40–49 the main differences between men and women were in the questions about frequency of urination during the day and holding back urine. Among the older groups men reported more symptoms on all questions apart from urination at night and difficulty in holding back urine, both of which were equally prevalent among men and women. CONCLUSIONS The overall prevalence of LUTS was high and showed no marked cultural variation. Prevalence increased with age, with severe LUTS commoner in older men. Women reported similar levels of the symptoms traditionally associated with LUTS in men. In each age group there were no major cultural differences in the frequency of LUTS. There were differences with age between men and women; younger men had a lower prevalence of LUTS than younger women but older men a much higher prevalence than older women. These findings emphasize that the IPSS should be confined to within‐patient comparisons and not used as a diagnostic tool. The IPSS performs very similarly regardless of gender.