Natural history of prostatism: Impaired health states in men with lower urinary tract symptoms

Purpose: Lower urinary tract symptoms are reported to have a significant impact on quality of life. However, the impact on specific aspects of health status is not clear. We evaluated the association between lower urinary tract symptoms, and physical and mental aspects of health using community based data from a cross-sectional component of a prospective cohort study. Materials and Methods: A total of 2,133 men 41 to 84 years old who were randomly selected from the Olmsted County, Minnesota population completed the 36-item health status questionnaire and a previously validated questionnaire assessing urinary symptoms. Eight domains, measured on a scale of 0 to 100, were used to assess general health status. Men were classified as having an impaired health status if they scored less than 75 points on the scale. Symptom severity (none, mild, moderate or severe) was measured from responses to the urinary symptom questionnaire. Results: The results demonstrated a cross-sectional decrease in mean health status scores for all 8 domains across levels of increasing urinary symptom severity. The strongest associations between health status scores and urinary symptoms (severe versus none) were observed for role limitation due to physical problems (odds ratio 15.7, 95% confidence interval 6.6 to 37.0), energy/fatigue (odds ratio 9.2, 95% confidence interval 4.7 to 18.1), role limitation due to emotional problems (odds ratio 8.7, 95% confidence interval 4.1 to 18.2) and general perception of health (odds ratio 7.2, 95% confidence interval 3.8 to 13.4). For these 4 dimensions men with mild urinary symptoms were also significantly more likely to have an impaired health status. Adjustment for age and co- morbidity did not alter the results. Conclusions: These findings suggest that urinary symptoms have a multidimensional association with physical and mental aspects of health. Although lower urinary tract symptoms may be the cause of an impaired health status, men with impaired health conditions may be more sensitive to prevalent urinary symptoms and more likely to report them. While the casual nature of this association has not been ascertained, these results may help to identify appropriate health dimensions to assess in patients with lower urinary tract symptoms.