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Prevalence of the lower urinary tract symptoms in men aged 50 years and above: A homoeopathic hospital-based study
*Corresponding author: Dr. Sangeeta Jain, MD, PhD Department of Anatomy, Dr. MPK Homoeopathic Medical College, Hospital and Research Center (A Constituent College of Homoeopathy University), Jaipur, Rajasthan, India. arihanthomoeo25@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Mathur S, Jain S, Mewara S. Prevalence of lower urinary tract symptoms in men aged 50 years and above: A homoeopathic hospital-based study. J Intgr Stand Homoeopathy 2021;4(2):55-8.
Abstract
Objectives:
Lower urinary tract symptoms (LUTS) are common in men and increase with age; more than 50% of men over 50-years-old are affected. Benign prostatic hyperplasia (BPH) is a common cause of LUTS such as urgency, frequency, and obstruction of urination and retention of urine. LUTS hamper patients’ life and occupation as well. In this study, we aimed to determine the prevalence of LUTS in men aged 50 years and above and association between LUTS severity and age in men.
Materials and Methods:
This was a cross-sectional study conducted in the outpatient department of the hospital attached to Homoeopathy University, Jaipur from October to December 2019. A total of 360 men aged 50 years and above were enrolled. They were screened using the American urological association symptom index and graded as having mild, moderate, or severe symptoms. For statistical analysis, Spearman’s correlation test and Chi-square test were applied with 95% confidence interval.
Results:
The prevalence of moderate to severe LUTS was 72.5% (n = 261; 95% confidence interval: 0.701–0.748). The adjusted analysis revealed that the incidence of LUTS was 64.6% (n = 115/178), 78.86% (n = 97/123), 82.22% (n = 37/45), and 85.71% (n = 12/14) in the age groups of 50–59 years, 60–69 years, 70–79 years, and 80–89 years, respectively. The severity of LUTS showed an increasing trend with increasing age (P < 0.05).
Conclusion:
LUTS are very common in men aged 50 years and above and their severity level increases with increasing age. The study also showed a positive correlation between patient age and the severity score of LUTS.
Keywords
Older men
Lower urinary tract symptoms
Prevalence
INTRODUCTION
Lower urinary tract symptom (LUTS) is a term used to describe a collection of symptoms that affect the control and quality of micturition in the lower urinary tract. LUTS are common among men and increase with age.[1] LUTS can present in two forms – (1) Voiding or obstructive symptoms such as hesitancy, poor and/or interrupted stream, straining, increased time for micturition, feeling of incomplete bladder emptying, and dribbling and (2) Storage or irritative symptoms such as frequency, urgency, incontinence, and nocturia.[2]
It has often been assumed that the pathophysiology of LUTS in older men is the result of bladder outlet obstruction associated with prostatic enlargement; there is sufficient evidence that after resection of the prostate, LUTS severity reduces.[3] The size of the enlarged prostate is not always directly correlated to the severity of the blockage or symptoms. Only up to 50% of men with prostatic enlargement have LUTS.[4]
Increasing age, functioning testicles, metabolic syndrome, family history of benign prostatic hyperplasia (BPH), obesity, history of diabetes, and being black are the common risk factors for LUTS related with BPH.[5] When men aged over 50 years complain of LUTS, various tests can be used to rule out all other possible causes before arriving at diagnosis of BPH:
Digital rectal examination[6] to assess the size, shape, and consistency of the prostate gland.
Prostate-specific antigen (PSA) level: [7] A PSA level of 1.5 ng/mL is often indicative of BPH.
Urinalysis[8] to exclude urinary tract infections, prostatitis, cystolithiasis, nephrolithiasis, renal cancer, and prostate cancer as causes of LUTS.
Prostatic ultrasound[5] to accurately evaluate the size, shape, anatomy, and potential pathology of the prostate in a minimally invasive, cost-effective, and reproducible way.
Blood urea nitrogen and creatinine[5] may be used for watching potential renal failure and complications associated with BPH.
Measuring post-void residual volume: A post-void residual volume measurement is recommended for patients with moderate or severe symptoms, defined by an American Urological Association Symptom Index (AUASI) score of 8 or greater.[9] The AUASI[10] is a subjective questionnaire that can be used to evaluate LUTS and their effect on patients with BPH. The AUASI comprises seven questions covering frequency, nocturia, weak urinary stream, hesitancy, intermittence, incomplete emptying, and urgency.
The objectives of the present cross-sectional study were to know the prevalence of LUTS in men aged 50 years and above, and the association of severity of LUTS in men with their age in the area of Sanganer, Jaipur, Rajasthan, India. A majority of the men in this region are farmers. This study is an attempt to enhance awareness regarding the early treatment of these symptoms, so that necessary steps for their prevention and treatment can be taken to improve the quality of life of our food generating population.
MATERIALS AND METHODS
Study design
Cross-sectional survey.
Study population
All men aged 50 years and above attending the outpatient department (OPD) of Dr. Girendra Pal Homoeopathic Hospital and Research Centre, between October and December 2019.
Study setting
The OPD of Dr Girendra Pal Homoeopathic Hospital, Homoeopathy University, Saipura, Sanganer, Jaipur, Rajasthan, India.
Study duration
Three months after approval of the proposal.
Sample size
A total of 360 men aged 50 years and above were screened.
Selection criteria
Inclusion criteria
Men aged 50 years and above who provided consent to participate in the study were included in the study.
Exclusion criteria
Patients who did not consent to participate in the study were excluded from the study.
Data collection procedure and instrument used
This study was conducted at AUASI questionnaire.[10]
Plan of analysis/statistical tools
Ethical consideration
The ethical clearance was obtained from the Institutional Ethical Committee of Homoeopathy University, Jaipur, Rajasthan, India, before conducting the study.
RESULTS
In this study, a total of 360 men aged 50 years and above were screened in 3 months; among these 360 patients, 245 (68.06%) had moderate LUTS, 99 (27.57%) had mild LUTS, and 16 (4.44%) had severe LUTS [Figure 1].
- Distribution of patients according to severity of the lower urinary tract symptoms.
[Table 1] shows the observations of the study population according to LUTS severity in relation to age.
| Age groups (years) | Mild | Moderate | Severe | Total |
|---|---|---|---|---|
| 50–59 | 63 (35.4%) | 112 (62.9%) | 3 (1.7%) | 178 |
| 60–69 | 26(21.1%) | 92 (74.8%) | 5 (4.1%) | 123 |
| 70–79 | 8 (17.8%) | 30 (66.7%) | 7 (15.6%) | 45 |
| 80–89 | 2 (14.3%) | 11 (78.6%) | 1 (7.1%) | 14 |
| Total | 99 (27.5%) | 245 (68.1%) | 16 (4.5%) | 360 |
LUTS: Lower urinary tract symptoms
The statistical [Table 2] shows a higher prevalence of moderate LUTS in men aged 50 years and above (68-06%) in comparison to mild (27.5%) and severe (4.44%).
| Prevalence of LUTS* | Confidence interval (95%) | |
|---|---|---|
| Total population | 72.50% (261/360) | 70–75% (0.701–0.748) |
| Mild | 27.50% (99/360) | 23–32% (0.228–0.321) |
| Moderate | 68.06% (245/360) | 66–71% (0.655–0.705) |
| Severe | 4.44% (16/360) | 03–06% (0.033–0.055) |
[Table 3] shows a significant association of age with the severity of LUTS. Spearman’s correlation coefficient (rho) is 0.253101.
| Age of the patient | LUTS score | |||
|---|---|---|---|---|
| Spearman’s rho | Age of the patient | Correlation coefficient Sig (two-tailed) | 1.000 | 0.253101 0.05 |
| N | 360 | 360 | ||
| LUTS Score |
Correlation coefficient Sig (two-tailed) | 0.253101 0.05 |
1.000 | |
| N | 360 | 360 |
“Correlation is significant at the 0.05 level (two-tailed).” LUTS: Lower urinary tract symptoms
DISCUSSION
This study was conducted to determine the prevalence of LUTS in men aged 50 years and above, and the association between LUTS severity and age in men. In this study, among 360 men, 261 (72.50%) reported LUTS; 245 (63.06%) showed moderate; and 16 (4.44%) showed severe symptoms. A Spearman’s correlation test was performed to examine association between age and LUTS severity. The association between these variables was significant (rho = 0.251301; n = 360). Results from population-based studies by Jacobsen et al.[16] have shown that the prevalence of moderate-to-severe LUTS and both increase with patient age. Lepor[3] showed that because the development of LUTS and prostatic enlargement are both age dependent, the development of LUTS in the aging male population has often been attributed to the enlarging prostate or BPH.
CONCLUSION
Men with BPH often develop LUTS; they may find the condition quite stressful. The results of present study have led us to conclude that prevalence of LUTS because of BPH is very common in men aged 50 years and above and its severity level increases with increasing age. In the age group of 50–59 years, the severity of LUTS is toward mild; and the severity level moves toward moderate to severe in men of aged 60 years and above.
Implication
The prevalence of LUTS among men is of concern and needs to be addressed appropriately. Treating and preventing these symptoms appropriately would greatly improve the quality of life of men with this problem. Keeping this context as the base of the article, investigations, diagnosis, and management take priority in ensuring patient well-being. Homoeopathy specializes in the system of medicine which does not treat the disease but the patient. This holistic approach of homoeopathy towards individuals corrects the disturbances in the vital force and heals the patient as a whole.
Acknowledgments
We sincerely thank the administrative and teaching faculty of Homoeopathy University, Jaipur, Rajasthan, India, for providing a conducive environment and moral support to accomplish this project.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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