Kuo-How Huang, Ming-Chih Lai, Shih-Ping Liu, Hong-Chiang Chang, Hong-Jen Yu, Ju-Ton Hsieh

Department of Urology, National Taiwan University Hospital

The Prevalence of LUTS in Taiwanese Men

Lower Urinary Tract Symtoms-LUTS

Voiding (Obstructive) symptoms:

Hesitancy

Intermittency

Incomplete voiding

Weak urinary stream

Straining to pass urine

Prolonged micturition

Terminal dribbling

Storage (Irritative) symptoms:

Frequency of urination

Nocturia

Urgency

Urge incontinence

Abrams P et al. New words for old: lower urinary tract symptoms for "prostatism". BMJ. 1994 ;9;308(6934):929-30.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=8173393

Preview

LUTS are a common problem affecting older men (Prevalence rate??)

Older men have higher incidence of LUTS than older women

A substantial number of men is underdiagnosed and undertreated for bothersome LUTS

Abrams P BMJ. 1994 Apr 9;308(6934):929-30. Boyle P, Robertson C, Mazzetta C, et al BJU Int. 2003 Sep;92(4):409-14.

Clinical Knowledge Summary; Benign Prostatic Hypertrophy

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=8173393http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=12930430http://www.cks.library.nhs.uk/guidance.asp?gt=Prostate%20-%20benign%20hyperplasia

Causes of LUTS in Men

Bladder

Detrusor instability

Neurogenic bladder

Peripheral neuropathy

Bladder tumors

Bladder calculi

Bladder infections

Prostate:

BPH: most common cause

Prostatitis

Prostate Cancer

Causes of LUTS in Men

Post prostatic

Urethral strictures

Polyps

Calculi

Meatal stenosis

Comorbid Conditions

DM

Parkinsons Disease

MS

CHF

CVA

Drugs

IPSS (International Prostate Symptom Score) (AUA-SI) 0-7: mild 8-19: moderate 20-35: severe

Incomplete emptying

frequency

intermittency

urgency

weak stream

straining

Nocturia

Quality of Life Index

Prevalence of LUTS in Men

The prevalence of men with moderate to severe IPSS in different countries Andersson

SO et al. BJU Int

94: 327331, 2004.

Prevalence of LUTS in men aged 4579 years: a population-based study of 39928 Swedish men

Andersson SO et al. BJU Int 94: 327331, 2004.

The frequency distribution of the severity of LUTS with age (n=39928) Andersson SO et al. BJU Int 94: 327331, 2004.

23%

Prevalence of LUTS in Men (USA MARSH study)

Glasser DB et al. Int J Clin Pract 61:1294-1300; 2007

Population-based study in USA (>40 y/o, n=2173)

IPSS8 46.2%

Prevalence of Moderate to Severe LUTS Asian Men

7588 men in 9 Asian countries and 146 men in Australia

Age (yrs) Asia (Japan; 9 countries)

Asia (Singapore; 5 countries)

Australia Korea

N=4072 N=1155 N=146 N=51440 to 49 18%50 to 59 29% 36% 36% 17.760 to 69 40% 50% 33% 23.3

70 to 79 56% 60% 37% 35.3Overall 41% 46% 31% 28%

Moderate to severe symptoms(IPSS8)

Homma Yet al. Int J Urol 1997;4: 406

(n=4072, Japan)

LUTS and male ED in Asia: a survey of ageing men from five Asian countries

1155 men aged 5080 years

Singapore, Philippines, Hong Kong, Malaysia, Thailand

Li MK et al. BJU Int 2005; 6:1339-54

Local data concerning Male LUTS Severity and Prevalence are Scarce in Taiwan

Prevalence of LUTS in Men- A Community-based Study in Taiwan

Yu HJ et al. JTUA 1995; 6:7-12.

N=272 men

IPSS8 26.1%

Prevalence of LUTS in Men- A Community-based Study in Taiwan

The prevalence of moderate to severe LUTS (IPSS8) was 26.1% (moderate: 23.6%, severe: 2.9%)

2.6% sought medical help

Yu HJ et al. JTUA 1995; 6:7-12.

Discussion

N=207 (> 40 years)

Evaluation: IPSS, DRE, PSA, Uroflowmetry

The prevalence of moderate to severe LUTS (IPSS8) was 49.8% (Severe : 9.7%; Moderate: 40.1%)

Positive correlation between IPSS and age (r = 0.380)

Negative correlation between IPSS and voided volume (r = -0.255), maximal flow rate (r = - 0.363), and mean flow rate (r = -0.401).

Chen et al. J Chin Med Assoc. 2003; 66(2):84-8

A community-based study in Taiwan

IPSS8

LUTS in Men-Overview

LUTS are highly prevalent in men in different countries (moderate to severe LUTS - 23 to 56%-- one third)

The prevalence rate of LUTS highly varies in different countries

The prevalence and severity of LUTS increase with age

Boyle P et al. BJU Int 92: 575580, 2003.Donovan JL et al. Br J Urol 80: 712721, 1997.Girman CJ et al. Urology 51: 428436, 1998.Hunter DJ et al. Urology 45: 962971, 1995.Mozes B et al. Qual Life Res 8: 9399, 1999.

Roberts RO et al. J Urol 157: 17111717, 1997.

Impact of LUTS on health status??

BPH in Taiwan (NHI database)

A retrospective study by NHI database (from 1997 to 2004)

A total of 19,510 men

The prevalence of men less than 50 years old with BPH is about 1.4% and increased to 44.6% for male over 70 years old

An average of 14.6% patients has comobidities like AUR, UTI

MrOS study Prevalence of LUTS in Older community- dwelling Men-USA

5284 men, >65y/o (exclude CaP)

Evaluation: AUA-SI (IPSS), SF-12, self- rated health status and activities of daily living

To study the associations beween LUTS severity and health status

Taylor BC et al. Urology 2006;68: 8049

Results:

The prevalence, severity, and dissatisfaction with LUTS increased with age

Increased LUTS was independently associated with increased impairment in health status and daily activity

Taylor BC et al. Urology 2006;68: 8049

Correlation with LUTS severity and QoL (in Sweden)

Andersson

SO et al. BJU Int

94: 327331,

2004.

Overview: Impact of LUTS on health statusSignificant correlation between

severity of LUTS and health status (HRQoL, QoL, Mental health, ED)

.Glasser

DB et al. Int

J Clin

Pract

61:1294-1300; 2007Taylor BC et al. Urology 68: 8049, 2006.

Andersson

SO et al. BJU Int

94: 327331, 2004.Boyle P et al. BJU Int

92: 575580, 2003.Donovan JL et al. Br J Urol

80: 712721, 1997.Girman

CJ et al. Urology 51: 428436, 1998.Hunter DJ et al. Urology 45: 962971, 1995.Mozes

B et al. Qual

Life Res 8: 9399, 1999.Roberts RO et al. J Urol

157: 17111717, 1997.

Kuo-How Huang, Ming-Chih

Lai, Shih-Ping Liu, Hong-Chiang Chang, Hong-Jen Yu, Ju-Ton Hsieh

Department of Urology, National Taiwan University Hospital

The Prevalence of LUTS in Taiwanese Men

Materials and methodsMaterials and methods

4321 men (aged 31 to 80) received health check-up in NTUH from March to December 2008.

3201 had adequate and proper data for analyses.

Evaluation: IPSS and uroflowmetry

AimAim

Analyze IPSS and uroflowmetry parameters in these men

Age effects on LUTS/Uroflow Statistics: Linear and multiple

regression analyses

Age Distribution of 3201 Men

400

945

1157

534

165

0

200

400

600

800

1000

1200

1400

31-40 41-50 51-60 61-70 71-80

Age

Cas

e N

umbe

r

Mean Qmax by Age

23.50 21.08 18.95 16.38 14.56 18.89

0.00

10.00

20.00

30.00

40.00

31-40 41-50 51-60 61-70 71-80 Total Mean

Qmax

IPSS Total Score by Age

4.44 5.68 7.50 10.09 10.69 7.680.00

10.00

20.00

31-40 41-50 51-60 61-70 71-80 Total Mean

Mean Qmean by Age

13.45 11.74 10.20 8.49 7.25 10.23

0.005.00

10.0015.00

20.00

31-40 41-50 51-60 61-70 71-80 Total Mean

Qmean

Mean Flow Time by Age

25.97 30.51 34.59 38.43 38.12 33.520.00

20.0040.0060.00

31-40 41-50 51-60 61-70 71-80 Total

Mean

Flow Time

LUTS Severity Distribution by Age

81%71%

60%

43%35%

61%

18%27%

34%

46% 50%

33%

1% 2%6%

11% 15%6%

0%

20%

40%

60%

80%

100%

31-40 41-50 51-60 61-70 71-80 Total Age

IPSS8 39%

Qmax > or < 15 mL/s by Age

88%80%

69%57%

44%

71%

20%31%

43%56%

29%

13%

0%

20%

40%

60%

80%

100%

31-40 41-50 51-60 61-70 71-80 Total

Age

15

15

Age Flow Time Qmax QmeanIPSS-1 6.8 (< 0.01) 3.1 (< 0.01) - -4.5 (< 0.01)IPSS-2 6.8 (< 0.01) - - -8.4 (< 0.01)IPSS-3 7.5 (< 0.01) 6.7 (< 0.01) - -7.3 (< 0.01)IPSS-4 11 (< 0.01) - 2.3 (0.02) -4.5 (< 0.01)IPSS-5 11 (< 0.01) 7.7 (< 0.01) - -7.2 (< 0.01)IPSS-6 6.6 (< 0.01) 6.3 (< 0.01) - -5.0 (< 0.01)IPSS-7 14 (< 0.01) - - -6.1 (< 0.01)Storage 13 (< 0.01) - - -8.6 (< 0.01)Voiding 10 (< 0.01) 7.3 (< 0.01) - -7.5 (< 0.01)Total 13 (< 0.01) 5.2 (< 0.01) - -8.1 (< 0.01)QoL 7.0 (< 0.01) 4.3 (< 0.01) - -5.7 (< 0.01)

Multiple Regression AnalysesMultiple Regression Analyses

Conclusions Conclusions 39% of Taiwanese men aged > 30 years old

have either moderate or severe LUTS. 29% of Taiwanese men aged > 30 years old

have a Qmax less than 15ml/s. Age is a main factor affecting the occurrence and

severity of LUTS Weak correlations between urolfowmetry

parameters and LUTS were noted

Thanks

Drawbacks of the current study: one time uroflow measurement,without some important data like prostate size, residual urine measurement,influence of medication, social-economic bias etc.

ConclusionConclusion

Severity of lower urinary tract symptoms (LUTS) Severity of lower urinary tract symptoms (LUTS) amongst the different age groups in men and women amongst the different age groups in men and women

(Hospital(Hospital--based; n=400)based; n=400)Apostolidis

A et al. Eur

Urol

2009 epub

Bother caused by lower urinary tract symptoms (LUTS) Bother caused by lower urinary tract symptoms (LUTS) in men and women reporting at least one symptom in men and women reporting at least one symptom

(Hospital(Hospital--based; n=400)based; n=400)Apostolidis

A et al. Eur

Urol

2009 epub

Display Settings: Abstract Format Summary Summary (text) Abstract Abstract (text) MEDLINE XML

PMID Li t

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lee%20E%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Yoo%20KY%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Prevalence of BPH in Men Pathological benign prostate hyperplasia in 1000

prostates 8% of men age 41-50 50% of men age 51-60 65% of men age 61-70 80% of men age 71-80 90% of men age 81-90 Only 40% of them have LUTS

Berry SJ et al. J Urol 1984; 132:474-9

Lower Urinary Tract Symtoms-LUTSPreviewCauses of LUTS in MenCauses of LUTS in Men 6Quality of Life IndexPrevalence of LUTS in MenThe prevalence of men with moderate to severe IPSS in different countriesPrevalence of LUTS in men aged 4579 years: a population-based study of 39928 Swedish menThe frequency distribution of the severity of LUTS with age (n=39928) Andersson SO et al. BJU Int 94: 327331, 2004.Prevalence of LUTS in Men (USA MARSH study)Prevalence of Moderate to Severe LUTS Asian Men 14LUTS and male ED in Asia: a survey of ageing men from five Asian countries 16 17Prevalence of LUTS in Men- A Community-based Study in TaiwanPrevalence of LUTS in Men- A Community-based Study in TaiwanDiscussion LUTS in Men-OverviewImpact of LUTS on health status??BPH in Taiwan (NHI database)MrOS studyPrevalence of LUTS in Older community-dwelling Men-USAResults:Correlation with LUTS severity and QoL (in Sweden)Overview: Impact of LUTS on health status 28Materials and methodsAim 31 32 33 34 35 36Conclusions 38ConclusionSeverity of lower urinary tract symptoms (LUTS) amongst the different age groups in men and women (Hospital-based; n=400)Bother caused by lower urinary tract symptoms (LUTS) in men and women reporting at least one symptom (Hospital-based; n=400) 42 43Prevalence of BPH in Men