Search

Lower urinary tract symptoms are highly prevalent and reduce quality of life. Lifestyle behaviors and the development of lower urinary tract symptoms have been largely unexamined. We investigated physical activity, smoking and alcohol drinking in relation to the development of lower urinary tract symptoms in men and women.Data were obtained from the BACH (Boston Area Community Health) Survey, a longitudinal observational study. Baseline (2002 to 2005) in-person interviews assessed activity, smoking and alcohol consumption. Five-year followup interviews (2006 to 2010 in 4,145) assessed new reports of moderate to severe lower urinary tract symptoms defined by the AUASI (AUA symptom index). Analysis was conducted using multivariable logistic regression.Lower urinary tract symptoms developed in 7.7% and 12.7% of at-risk men and women, respectively. Women were 68% less likely to experience lower urinary tract symptoms (OR 0.32; 95% CI 0.17, 0.60; p0.001) if they had high vs low levels of physical activity. Although the association was similar among men, it was not statistically significant upon adjustment for medical or sociodemographic characteristics in the multivariable model. Women smokers were twice as likely to experience lower urinary tract symptoms, particularly storage symptoms (OR 2.15; 95% CI 1.30, 3.56; p = 0.003), compared to never smokers. Among men, smoking was not associated with lower urinary tract symptoms. Results for alcohol intake were inconsistent by intake level and symptom subtype.A low level of physical activity was associated with a 2 to 3 times greater likelihood of lower urinary tract symptoms. Smoking may contribute to the development of lower urinary tract symptoms in women but not in men. Clinicians should continue to promote physical activity and smoking cessation, noting the additional potential benefits of the prevention of lower urinary tract symptoms, particularly for women.

Studies suggest that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) may lower oestrogen levels in women. However, no large, population-based studies have assessed NSAID/hormone associations in men. Our objective was to examine the association between use of prescription and over-the-counter NSAIDs, and levels of oestrogens and androgens in men.The Boston Area Community Health Survey, an observational survey with initial data collection in 2002-2005.A total of 1766 men who provided a blood sample and data on recent analgesic use.Adjusted geometric mean levels of androgens, oestrogens, SHBG, LH and FSH for each category of NSAID use and the per cent difference in hormone levels for users vs nonusers.There was no significant association between prescription/over-the-counter NSAID use and any hormone examined after adjustment for potential confounders. For example, geometric mean testosterone levels were 13·8, 13·6 and 14·2 nM in nonusers, prescription users and over-the-counter NSAID users, respectively; the corresponding levels for estradiol were 80·3, 70·4 and 79·9 pM. In stratified analyses, however, prescription NSAID use was associated with lower testosterone, estradiol and estrone levels in obese men and lower testosterone and dehydroepiandrosterone sulphate levels in inactive men.While overall these data do not provide strong support for an association between NSAID use and hormone levels in men, prescription NSAIDs may decrease levels of certain oestrogens and androgens in obese and inactive men.

Study Type - Prevalence (inception cohort) Level of Evidence 1b What's known on the subject? and What does the study add? Certain antihypertensives, particularly diuretics and calcium channel blockers, are known to be associated with increased risk of LUTS including nocturia, but little is known about gender-specific effects. This is the first epidemiological study, to our knowledge, to compare the prevalence of several urological symptoms (storage, voiding and nocturia) among male and female users of a wide variety of common antihypertensives using a community-based sample.To examine differences in the prevalence of lower urinary tract symptom (LUTS) among users of five common AHT classes compared with non-users, adjusted for LUTS risk factors in a large, representative sample.Data were from the Boston Area Community Health Survey, a population-based study of community-dwelling male and female (30-79 years) residents of Boston, MA, USA for whom prescription drug information was collected between 2002 and 2005. The urological symptoms of storage, voiding, and nocturia were assessed using interviewer-administered questionnaires and the American Urological Association Symptom Index. This analysis was conducted among 1865 participants with an AHT indication. Associations of angiotensin-converting enzyme inhibitors, beta blockers, calcium channel blockers (CCBs) and loop and thiazide diuretics with the three groups of LUTS were estimated using odds ratios (ORs) and 95% confidence intervals (CIs) from multivariate logistic regression (referent group: untreated hypertension). Overlap in use was accounted for using monotherapy and combination therapy exposure categories.Among women, monotherapy with CCBs was associated with increased prevalence of nocturia (OR = 2.65, 95% CI: 1.04-6.74) and voiding symptoms (OR = 3.84, 95% CI: 1.24-11.87); these results were confined to women aged55 years. Among men of all ages, positive associations were observed for thiazides and voiding symptoms (monotherapy OR = 2.90, 95% CI: 1.17-7.19), and loop diuretics and nocturia (combination therapy OR = 2.55, 95% CI: 1.26-5.14).Results are consistent with the hypothesis that certain AHTs may aggravate LUTS. The presence of new or worsening LUTS among AHT users suggests medications should be reviewed and a change in AHT class considered.

To determine, qualitatively and quantitatively, how individuals use fluid manipulation to self-manage the urinary symptoms of daytime frequency, urgency and urine leakage and the underlying rationale for this behaviour.Lower urinary tract symptoms are prevalent and burdensome, and little is known about how individuals with lower urinary tract symptoms manipulate their fluid intake.A mixed methods design included statistical analysis of data from a population-based survey of urologic symptoms and qualitative analysis of in-depth interviews.Quantitative data came from 5503 participants of the baseline Boston Area Community Health Survey, a population-based, random sample epidemiologic survey of urologic symptoms. Qualitative data came from in-depth interviews with a random subsample from Boston Area Community Health of 152 black, white and Hispanic men and women with LUTS.Qualitative data showed that some respondents restricted fluid intake while others increased it, in both cases with the expectation of improved symptoms. Quantitative data showed that fluid intake was greater in men and women reporting frequency (p0·001). Women with frequency drank significantly more water (p0·001), while women with urgency drank significantly less water (p = 0·047).This study found divergent expectations of the role of fluids in alleviating symptoms, leading some individuals to restrict and others to increase fluid intake. Individuals with lower urinary tract symptoms may need guidance in fluid management.Nurses should be aware that patients may self-manage lower urinary tract symptoms by restricting fluid intake, putting them at risk for dehydration, constipation and urinary tract infection, but also that they may be increasing their fluid intake, which could worsen symptoms. This study pinpoints a specific area of need among patients with lower urinary tract symptoms and provides a practical opportunity for nurses to assist their patients with behavioural and fluid management by emphasising the clinical guidelines.

Racial/ethnic disparities in nocturia prevalence have been reported previously. We estimated nocturia prevalence rates by race/ethnicity and determined the contribution of socioeconomic status to potential differences by race/ethnicity.The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,501 adults, including 2,301 men and 3,200 women, who were 30 to 79 years old. Nocturia was defined as voiding more than once per night in the last week or voiding more than once per night fairly often, usually or almost always in the last month. Self-reported race/ethnicity was defined as black, Hispanic and white. Socioeconomic status was defined as a combination of education and household income.The overall prevalence of nocturia was 28.4% with a higher prevalence in black and Hispanic participants compared to white participants (38.6% and 30.7%, respectively, vs 23.2%), a trend that was consistent by gender. After adjusting for socioeconomic status the increased odds of nocturia in Hispanic men disappeared (adjusted OR 1.04, 95% CI 0.71, 1.52), while the OR in black men was attenuated but remained statistically significant (OR 1.57, 95% CI 1.12, 2.21). In women the association between race/ethnicity and nocturia was attenuated but remained statistically significant after adjusting for socioeconomic status.Socioeconomic status accounts for part of the racial/ethnic disparities in prevalence of nocturia. The effect of socioeconomic status was more pronounced in men and in Hispanic participants, while differences in nocturia prevalence remained significant in black men and women.