A Community Based Study of Prostatic Symptoms in Singapore

Prevalence and correlations of lower urinary tract symptoms, erectile dysfunction and incontinence in men from a multiethnic Asian population: results of a regional population-based survey and comparison with industrialized nations

OBJECTIVE

To determine, in a population-based survey, the prevalence of lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and incontinence in community-dwelling men in multiethnic Malaysia, as currently available Western demographic data might not be applicable in the Asian population.

SUBJECTS AND METHODS

A cross-sectional population-based survey was carried out in the State of Penang, Malaysia, with a target population of men aged > or = 40 years. Using a multistage study design, random systematic sampling was used to represent the target population, who were weighted based on ethnicity and rural-urban ratios so as to represent the general population distribution. Trained field-workers conducted direct interviews and administered the American Urological Association Symptom Index (AUA-SI), the International Index of Erectile Function (IIEF-5) questionnaire and questions on incontinence based on the International Continence Society 2002 definition.

RESULTS

In all, 418 men aged > or = 40 years were interviewed, of whom 353 completed the AUA-SI questionnaire (84.5% response rate). The prevalence of mild, moderate and severe LUTS was 80.6%, 6% and 0.3%, respectively. The prevalent symptoms were frequency and nocturia. There was moderate and severe ED in 45.9% of men, whereas incontinence was reported by 8.2%. The AUA-SI correlated strongly with age (R = 0.291, P < 0.001), IIEF-5 (R = - 0.265, P < 0.001) and diabetes mellitus.

CONCLUSION

The prevalence and severity of LUTS, ED and incontinence increased with age in this multiethnic Asian population, in which ED correlated strongly with LUTS. Compared to the Western population, the prevalence of LUTS was significantly lower, while the prevalence of ED and incontinence were comparable.

Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60–80 years

OBJECTIVE

To study the prevalence and bother of nocturia, and sleep interruptions in an unselected population of Danish men and women aged 60-80 years.

SUBJECTS AND METHODS

A postal questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System, in which every person living in Denmark is identified. The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) was used to evaluate nocturia and bother, and sleep interruptions. Nocturia was defined as waking at night to void, according to the International Continence Society definition.

RESULTS

In all, 92% (3664) subjects returned the questionnaire; 71% completed the questionnaire satisfactorily and were included in the study. The prevalence of nocturia increased with age. The overall prevalence of nocturia was 77% and there was no difference between men and women (P = 0.11), but men had slightly more severe nocturia than women. The bother caused by nocturia in men and women increased with the severity of nocturia, and women were slightly more bothered than men when the degree of nocturia was >2 voids/night. Nocturia was the most frequent self-reported reason for waking at night, followed by thirst.

CONCLUSION

The prevalence of nocturia increased with age. There was no difference between the genders in the overall prevalence of nocturia, but nocturia of > or = 2 voids/night was more frequent in men. The degree of bother increased with the severity of nocturia, even after correcting for generic quality of life, and the younger groups were the most bothered. Nocturia was the major reason for waking at night, followed by thirst.

Web-based research of lower urinary tract symptoms that affect quality of life in elderly Japanese men: analysis using a structural equation model

OBJECTIVE

To investigate the distribution of lower urinary tract symptoms (LUTS) in elderly Japanese men, to clarify which variables contributed to medical care-seeking behaviour, and to construct a structural-equation model (SEM) to explain overall quality of life (QoL).

SUBJECTS AND METHODS

A dataset was obtained from 662 Japanese men aged 50-79 years who participated in the programme by accessing a website via the Internet between 10.30 hours on 19 February 2003 and 10.30 hours on 24 February 2003. The participants were queried about their International Prostate Symptom Score (IPSS), bother, QoL index and medical care-seeking behaviour.

RESULTS

Of the 662 participants, 314 reported intending to seek medical care for LUTS (intention group); the remaining 348 answered that they did not intend to see a doctor (no-intention group). The characteristic of weak stream had the strongest correlation with the QoL index, not only in the intention (r = 0.58) but also in the no-intention group (r = 0.48). Among several SEMs proposed, one that included a latent variable termed 'QoL sensitivity' was the most appropriate to explain overall QoL. In this model it was assumed that 'QoL sensitivity' was affected by other latent variables, termed the 'voiding symptom factors' and 'storage symptom factors', and affected the degree of bother related to each symptom.

CONCLUSION

In Japanese men, voiding symptoms, especially weak stream, contributed to overall QoL for medical care-seeking behaviour. Differences in 'QoL sensitivity' among men may be one of the reasons why symptomatic severity is not always correlated with symptom-related bother.

Incidence, prevalence and management of lower urinary tract symptoms in men in the UK

OBJECTIVE

To describe the incidence, prevalence and management of lower urinary tract symptoms (LUTS), suggestive of benign prostatic hyperplasia, reported in UK general practice.

PATIENTS AND METHODS

All clinical information relating to LUTS and its treatment was assessed for men aged > or = 45 years and registered on the UK General Practice Research Database (GPRD) at some time between 1992 and 2001. Incidence and prevalence were derived from the GPRD population. Secular trends in the management of LUTS were examined from prescribing rates and the intervals between first symptoms, first treatment and surgery or catheterization.

RESULTS

The incidence of reported LUTS showed a strong linear increase with age. The prevalence increased from 3.5% for men aged 45-49 years to > 30% for men aged > 85 years. Between 1992 and 2000 there was a five-fold increase in the proportion of time with LUTS when men were receiving medical treatment. This was accompanied by a progressive decrease in the intervals between first symptoms and first drug treatment, and a significant increase in the intervals from first symptoms or first treatment to surgery or catheterization. Treated men received surgery or catheterization significantly later than those receiving no drug treatment.

CONCLUSION

There has been a significant increase in the use of medical therapy for LUTS over the last decade. The accompanying postponement of surgery/catheterization is likely to be a result, at least in part, of successful earlier medical treatment and the treatment of a greater proportion of symptomatic men.

Differences in prostate disease symptoms and visits to the general practitioner among three ethnic groups in New Zealand

OBJECTIVE

To define lower urinary tract symptoms (LUTS) and their relationship to general practitioner (GP) visits and ethnicity among men in the New Zealand (NZ) population-based Wellington Region Community Prostate Study.

SUBJECTS AND METHODS

In 2001-2002 NZ European, Maori and Pacific Island participants were selected from the Wellington region of NZ. Demographic questions, the International Prostate Symptom Score and yearly GP attendance questions were completed by 862 subjects with no history of prostate cancer.

RESULTS

There were no significant differences in LUTS among the ethnic groups (P = 0.80) but symptom scores were positively correlated with age only for NZ Europeans (P < 0.001, r = 0.179). Overall, NZ populations have a lower prevalence of LUTS than is evident for ethnic groups in other countries. Pacific Islanders attended the GP more often than both NZ Europeans and Maori.

CONCLUSION

Ethnic differences in age-related urinary symptoms and visits to the GP are important for informing culturally appropriate clinical practice and prostate health promotion with minority groups.