The Impact of LUTS on HRQL, Anxiety, Depression and Treatment Seeking


Introduction and Objectives: Multiple LUTS frequently co-occur, but little is known about the prevalence and patient impact of symptom combinations. A large, multi-country epidemiological study examined the prevalence and impact of LUTS in men and women over 40 in the US, UK, and Sweden.

Materials: This cross-sectional, population-representative survey was conducted via the Internet in the US, UK, and Sweden. Target samples were determined from the population census demographics. Members of web-based panels were randomly selected to receive an email invitation to participate in the survey. If interested, respondents clicked on a link to an informed consent followed by the survey. Participants were asked to rate how often they experienced a symptom during the past 4 weeks on a 5-point Likert scale, and, if experienced, how much the symptom bothered them. Other patient outcomes included urinary-specific HRQL (OABq-SF), generic health (SF-12), anxiety and depression (HADS), and treatment-seeking behavior.

Results: The response rates for the US, UK, and Sweden were 59.6%, 60.6% and 52.3%, respectively, with a final sample of 30 000 (US: 20 000; UK: 7 500; SW: 2 500). Mean age was 56.6 years; 82.9% White, 6.7% Black, 6.0% Hispanic, and 4.4% other. Each sample represented the population census of each country. Of those reported, 45% of men and 48% of women reported at least 1 LUTS > “often.” LUTS were subgrouped in mutually exclusive subgroups according to ICS definitions. Storage symptoms alone (nocturia, frequency, urgency, incontinence) were the most frequent LUTS reported > “often” for both men (13%) and women (25%). Significant differences (P < 0.001) were found across outcomes between the No LUTS group and the Voiding only, Voiding + Post-micturition, Storage + Post-micturition, Voiding + Storage, and Voiding + Storage + Post-micturition groups. Men and women with a combination of voiding, storage, and post-micturition symptoms reflected the greatest levels of impairment and highest percentages of treatment-seeking behaviors, followed by those in the Voiding + Storage and Storage + Post-micturition groups for the majority of indices (Table). Women reported lower levels of HRQL and generic health and higher rates of anxiety and depression than men. Storage symptoms were associated with significantly higher rates of treatment-seeking behavior. Swedish respondents reported higher levels of HRQL and lower rates of anxiety and depression than their US and UK counterparts.

Conclusions: LUTS, whether alone or in combination, are highly prevalent among men and women over 40. Those with multiple symptoms, particularly those in combination with storage symptoms, tend to have lower levels of HRQL and generic health and higher rates of anxiety, depression, and treatment seeking.

KEYWORDS: Lower urinary tract symptom, anxiety, depression; epidemiology; quality of life


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