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Objective: The aim of this study was to determine the severity and bother of lower urinary tract symptoms (LUTS) and evaluate the burden of each symptom in a male population., Materials and Methods: Postal questionnaires were sent to 7470 men aged 30-80 years. The Danish Prostatic Symptom Score (DAN-PSS-1) was used to determine the severity, bother and total symptom score for each symptom. To assess the total burden of each symptom at the population level, the total symptom scores were weighted by the prevalence they represented., Results: The overall response rate was 58.7% (4384/7470 men). Urgency caused the greatest burden to men aged 30-80, with a prevalence-weighted symptom score of 0.712. Urgency affected 66.2% of men and 5.1% experienced moderate symptoms with moderate bother. Post-micturition dribble caused the second greatest burden, with a prevalence-weighted score of 0.704, affecting 58.7% of men and with 31.1% reporting mild bother from it. Nocturia and feeling of incomplete emptying caused the third and fourth greatest burdens, respectively. In young men (aged 30 and 40 years), post-micturition dribble caused the greatest burden, as moderate symptoms were common and caused mild bother to 11.4%. Among retired (70 and 80 years) and middle-aged (50 and 60 years) men, urgency was the most burdensome symptom., Conclusions: The most burdensome LUTS in men aged 30-80 years was urgency, followed by post-micturition dribble, nocturia and feeling of incomplete emptying. Urgency and nocturia were prominent in old men and post-micturition dribble was noted in young men.

Objective: To estimate the bother using both population- and individual-level bother of lower urinary tract symptoms (LUTS) across a wide age range among men., Materials and Methods: A total of 7470 men aged 30-80 years were approached using a postal questionnaire in 2004. The overall response was 58.7% (4384 respondents). The Danish Prostatic Symptom Score was used to evaluate bother of 12 LUTS. In the population-level analysis, prevalence of bother was calculated by relating the number of men with bother to the population size (instead of only affected men). To evaluate the bother at individual level, its prevalence among the men experiencing the symptom was assessed., Results: In the population-level analysis, postmicturition dribble was the most common cause of bother among 30- and 40-year-old men, as 25% of the men experienced small bother and 4.5% had moderate to major bother. Men aged 70-80 years experienced the most bother from urgency followed closely by nocturia, with about 40% reporting small bother and roughly 20% moderate or major bother. When only symptomatic men were evaluated, incontinence symptoms, especially urge incontinence, were the most bothersome as more than 80% of the men with incontinence reported bother., Conclusion: At population level, the most bothersome symptom varied by age. Men aged 30-40 years experienced bother most commonly from postmicturition dribble. With increasing age, urgency and nocturia became the most bothersome symptoms by age 70-80 years. At individual level, incontinence symptoms were the most bothersome LUTS, with less influence by age., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To compare outcome of lower urinary tract symptoms (LUTS) between men with medical and surgical treatment., Materials and Methods: A questionnaire was mailed to men aged 55, 65 and 75 years living in Tampere region, Finland in 1999 and the survey was repeated in 2004. LUTS were evaluated using DAN-PSS-1 questionnaire. A total of 1679 men (68% of the eligible) responded to both questionnaires. Of them, 114 men reported LUTS at baseline and medical treatment in the repeat survey and 47 men with LUTS had received surgical treatment. Seventy-two men with prostate cancer were excluded. Men with no medical treatment or surgery for LUTS in either questionnaire were included to no-treatment group., Results: The men after surgical treatment showed a reduction in all LUTS symptom groups. However, among the medically treated and untreated men, all the symptoms worsened during the follow up. The proportion of symptomatic men after surgery was lower than among the medically treated men. In men with medical treatment, the prevalence of all 12 LUTS increased. Dysuria and postmicturition dribble were the only symptoms that had slightly better results in medical than in surgical treatment group., Conclusions: In this population-based study, operative treatment seemed to relieve LUTS, whereas medical treatment only slowed down their progression. These findings suggest that men with surgical treatment experience a more favourable outcome in LUTS than those receiving medical treatment., (© 2013 John Wiley & Sons Ltd.)

Objective: To evaluate the natural course of lower urinary tract symptoms (LUTS) by quantifying their longitudinal changes., Methods: A population-based study of men aged 55, 65, or 75 years in Pirkanmaa region, Finland was conducted with a 5-year follow-up (1999-2004). Mailed self-administered questionnaire with the Danish Prostatic Symptom Score instrument was used to evaluate LUTS. Men with any treatment for LUTS or a history of prostate cancer were excluded., Results: A total of 1331 men were included in the study. All 12 symptoms exhibited considerable fluctuation over time. Incidence of specific symptoms varied by a factor of 10 and remission by a factor of 4. Overall, common symptoms varied most strongly in terms of incidence and remission, whereas the less common ones such as incontinence behaved in a more stable fashion. Remission was more frequent than incidence for all individual LUTS components. The highest incidence was found for post-micturition symptoms and urgency. Remission was most common in weak stream and least frequent in urgency and urgency incontinence., Conclusion: LUTS are dynamic conditions with strong spontaneous fluctuation over time. Remission was more common than incidence. The strong propensity for spontaneous resolution should also be borne in mind in treatment decisions including prescription practices., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The ICS has divided LUTS into three groups: storage, voiding and post-micturition symptoms. The classification is based on anatomical, physiological and urodynamic considerations of a theoretical nature. We used principal component analysis (PCA) to determine the inter-correlations of various LUTS, which is a novel approach to research and can strengthen existing knowledge of the phenomenology of LUTS. After we had completed our analyses, another study was published that used a similar approach and results were very similar to those of the present study. We evaluated the constellation of LUTS using PCA of the data from a population-based study that included >4000 men. In our analysis, three components emerged from the 12 LUTS: voiding, storage and incontinence components. Our results indicated that incontinence may be separate from the other storage symptoms and post-micturition symptoms should perhaps be regarded as voiding symptoms., Objective: To determine how lower urinary tract symptoms (LUTS) relate to each other and assess if the classification proposed by the International Continence Society (ICS) is consistent with empirical findings., Materials and Methods: The information on urinary symptoms for this population-based study was collected using a self-administered postal questionnaire in 2004. The questionnaire was sent to 7470 men, aged 30-80 years, from Pirkanmaa County (Finland), of whom 4384 (58.7%) returned the questionnaire. The Danish Prostatic Symptom Score-1 questionnaire was used to evaluate urinary symptoms. Principal component analysis (PCA) was used to evaluate the inter-correlations among various urinary symptoms., Results: The PCA produced a grouping of 12 LUTS into three categories consisting of voiding, storage and incontinence symptoms. Post-micturition symptoms were related to voiding symptoms, but incontinence symptoms were separate from storage symptoms. In the analyses by age group, similar categorization was found at ages 40, 50, 60 and 80 years, but only two groups of symptoms emerged among men aged 70 years. The prevalence among men aged 30 was too low for meaningful analysis., Conclusions: This population-based study suggests that LUTS can be divided into three subgroups consisting of voiding, storage and incontinence symptoms based on their inter-correlations. Our empirical findings suggest an alternative grouping of LUTS. The potential utility of such an approach requires careful consideration., (© 2012 BJU International.)

Objective: The aim of this study was to determine the prevalence and bother of postmicturition dribble in relation to age in the male population., Material and Methods: Information for a population-based study was collected by means of a mailed self-administered questionnaire, which was returned by 4384 men out of 7470 (58.7%). The participants were men aged 30-80 years from the Pirkanmaa Region in Finland. The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire was used to evaluate their urinary symptoms. SPSS was used in the data analysis. Two-sided chi-squared test and Kendall tau-b test were used for analysis., Results: The overall prevalence of postmicturition dribble was 58.1% (95% confidence interval 56.6-59.6). Prevalence of postmicturition dribble increased with age (p < 0.001). In men aged 60-80 years, two-thirds reported postmicturition dribble and approximately one out of four had dribbling into their trousers after voiding. In the 30-year-old group, over 40% reported postmicturition dribble and almost one out of five had also dribbling into their trousers. One out of five men in the 30-year-old group reported minor bother; the proportion of men reporting bother increased with age to one-third of the men in the oldest cohort (p < 0.001)., Conclusions: The prevalence of the postmicturition dribble was found to be high in this survey. Half of the 30-year-old men and two-thirds of the men aged 60-80 years had postmicturition dribble. Dribbling into trousers increased with age but as a severe symptom, it was rare (0.5%). Minor problems from postmicturition dribble were common, but major bother occurred seldom (1.1%).

Unlabelled: Study Type--Therapy (symptom prevalence). Level of Evidence 2a. What's known on the subject? and What does the study add? In several population-based studies the prevalence of hesitancy has varied from 20% to 52%. Studies concern mostly older men ≥50-years-old. Knowledge of troublesomeness that hesitancy causes is very scarce. This is a large population-based study on hesitancy in men with a wide age range. This study reports the prevalence of hesitancy from 30-year-old men to 80-year-old men. The bother of hesitancy is reported and this is also presented in different age groups., Objective: • To estimate the prevalence and bother of hesitancy by age group., Materials and Methods: • In this population-based study, the target population was 30- to 80-year-old men from Pirkanmaa County, Finland. • Information was collected by means of a mailed self-administered questionnaire in 2004. The overall participation proportion was 58.7% (4384 men out of 7470). • The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire was used to evaluate urinary symptoms, particularly hesitancy. Logistic regression was used for multivariate analysis., Results: • Almost half of the men (46.8%, 95% CI 45.3-48.3%) reported hesitancy at least occasionally, but only 0.5% (95% CI 0.3-0.7%) had hesitancy every time they urinated. The prevalence of any hesitancy was 42.3% at 30 years and 50.5% at 80 years of age (trend P < 0.001). Only a few men reported hesitancy often or always, prevalence increasing with age from 2.6% to 11.4% (trend P < 0.001). • Hesitancy caused a small problem for 18.3% of the men and a moderate or major problem for 0.9-5.3%. Only 3% of the men with infrequent hesitancy reported more than a small problem, whereas 59% of the men with hesitancy often or always reported a small problem and 32% reported a moderate or major problem. • Two other voiding symptoms, straining and weak stream, were strongly associated with hesitancy (with odds ratios exceeding 80)., Conclusions: • Mild hesitancy is very common in men of all ages. • Severe cases are rare, but the prevalence increases with age. • Hesitancy is a well-tolerated urinary symptom., (© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.)

Purpose: We assessed the effects of depressive symptoms on the incidence of nocturia in men., Materials and Methods: The target population comprised all men who were 50, 60 or 70 years old and residing in the Tampere area in 1994. A self-administered questionnaire was mailed to 3,143 randomly selected men in 1994 and a second round was mailed to the 2,837 who were alive and eligible in 1999. The followup sample consisted of 1,580 men with information on nocturia available at baseline and followup., Results: The incidence of mild to severe nocturia was 75 cases per 1,000 person-years (95% CI 66-85) and that of moderate or severe nocturia was 9 (95% CI 7-11). Men with depressive symptoms at study entry were at 2.8 times higher risk (95% CI 1.5-5.2) for moderate or severe nocturia than those without depressive symptoms. A dose response relation was found between the severity of depressive symptoms at baseline and the incidence of moderate or severe nocturia. Each unit increment in the short form of the Mental Health Inventory score on a scale of 5 to 30 increased the incidence rate ratio of moderate or severe nocturia by 10% (95% CI 4-16). Only untreated depressive symptoms increased the incidence of moderate or severe nocturia (adjusted RR 3.3, 95% CI 1.7-6.2) but not medically treated symptoms. Nocturia at study entry had no significant effect on depressive symptoms during followup., Conclusions: Our findings show a unidirectional effect of depressive symptoms on the incidence of moderate or severe nocturia. Untreated depressive symptoms may cause nocturia.

Objectives: To quantify the bothersomeness of urinary symptoms in males with lower urinary tract symptoms (LUTS)., Methods: A population-based postal survey of urinary symptoms among 2837 men aged 55, 65, or 75 years was conducted. The response rate was 75%, and data of both symptom and bother questions were eligible for 1803-2046 men, depending on the question. Bothersomeness of each urinary symptom was measured with a bother index (BI) as a ratio of the number of men with a bother score higher than a symptom score to that with a bother score lower than a symptom score. The BI was compared with the relative risk (RR), the prevalence of men with bother to those with symptom., Results: Urgency (46%) and postmicturition dribble (42%) were the most common symptoms. Any type of incontinence was considered highly bothersome (BI: 1.79-3.70). In light of the BI, most voiding and postmicturition symptoms except weak stream (BI: 1.14) were well tolerated. The variation of the BI (0.06-3.70) was substantially larger than that of RR (0.53-0.89) of the urinary symptoms., Conclusions: Bothersomeness of a symptom is an independent contribution in the assessment of LUTS. The BI may be a useful indicator of bothersomeness of urinary symptoms. The greater variation of the BI than that of RR indicates that the BI provides information on LUTS that cannot be described by prevalence or prevalence ratio only.

Purpose: We estimated the incidence and natural course of nocturia in an unselected Finnish male population., Materials and Methods: A mail interview of a cohort of 3,143 randomly selected men 50 to 70 year old at study entry was done in Finland in 1994, 1999 and 2004. The questionnaire included questions on sociodemographic status, overall health and disease, urinary symptoms, sexual functioning and symptom bother. The overall response rate was 70% on the 1994 survey, 75% on the 1999 survey and 76% on the 2004 survey. A response to nocturia questions was obtained from 1,633 men at the 1994 to 1999 followup and from 1,618 at the 1999 to 2004 followup., Results: The overall prevalence of 1 or more nocturnal voidings was 56% at baseline and 74% 10 years later. The crude incidence rate for nocturia was 75 new cases per 1,000 men annually (95% CI 66 to 85) during the first 5-year followup period and 126/1,000 (95% CI 113 to 140) during the second period. The incidence of moderate or severe nocturia was 9/1,000 (95% CI 7 to 11) and 14/1,000 men (95% CI 12 to 17), respectively. Incidence and prevalence increased clearly with age but also by calendar time, which was most prominent for the mild nocturia incidence. The incidence of moderate to severe symptoms increased, especially in the oldest cohort (incidence density ratio 5.6 to 5.7/5 years)., Conclusions: Every year 10% more males older than 50 years start to void during the night. The incidence of mild nocturia increases, especially in men when they age from 50 to 60 years. In older men mild symptoms are more stable but the incidence of severe nocturia increases strongly after age 75 years.

Purpose: We determined the effect of lower urinary tract symptoms (LUTS) on the incidence of erectile dysfunction (ED)., Materials and Methods: The target population consisted of all men 50, 60 or 70 years old residing in Tampere area, Finland in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. The followup sample consisted of the 1,683 men who responded to baseline and followup questionnaires. We estimated the effect of LUTS and bother on the incidence of ED during the 5-year followup among the 1,126 men free from ED at baseline. ED was assessed by 2 questions on subject ability to achieve and maintain erection sufficient for intercourse and LUTS assessed by the Danish Prostatic Symptom Score. Logistic regression model was used in the multivariate analysis., Results: The incidence of ED increased with the presence and with the intensity of urinary symptoms and bother at baseline. Compared with men with LUTS score 0, the incidence of ED was 2.7 (95% CI 1.3-5.5) times higher among men with score 7 to 11, and 3.1 times with score 12 or more. The incidence of ED increased by 5% for each 1-point increment in LUTS score, while it increased by 12% and 11% for 1-point increment in cumulative symptom or bother score, respectively. Men with cumulative symptoms or bother score 4 or more were significantly 2.0 to 2.7 times at higher incidence of ED relative to those who were free from symptoms or bother at baseline. Only overflow incontinence (OR = 2.2) and incomplete emptying (OR = 1.8) independently increased the incidence of ED., Conclusions: Lower urinary tract symptoms and bother independently increase the incidence of erectile dysfunction.