title: Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men.
abstract: OBJECTIVE
  We determined the metabolic, lifestyle and physical factors associated with progression or improvement of storage and voiding lower urinary tract symptoms in a population based cohort of men.
  
  
  METHODS
  After the exclusion of men with prostate or bladder cancer and/or surgery from the study, progression and improvement of storage and voiding lower urinary tract symptoms was assessed using the AUA-SI (American Urological Association symptom index) in 780 men, age 35 to 80 years at baseline, who attended 5-year followup clinics.
  
  
  RESULTS
  Storage and voiding lower urinary tract symptoms progressed in 39.8% (308) and 32.3% (250) of men, and improved in 33.1% (256) and 23.4% (181), respectively. In final adjusted regression models greater bother and physical activity at baseline predicted improvement in storage and voiding lower urinary tract symptoms, while greater income, high-density lipoprotein cholesterol and lower triglycerides predicted improvement of storage lower urinary tract symptoms only. Being widowed, higher plasma estradiol and depression at baseline predicted the progression of storage and voiding lower urinary tract symptoms, while greater abdominal fat mass and obstructive sleep apnea risk predicted the progression of storage lower urinary tract symptoms only. Older age, lower high-density lipoprotein cholesterol, testosterone, income, previous benign prostatic hyperplasia and erectile dysfunction at baseline predicted the progression of voiding lower urinary tract symptoms only. The initiation or continued use of α-blockers or anticholinergics (storage lower urinary tract symptoms), and 5α-reductase inhibitors (voiding lower urinary tract symptoms), were associated with symptom improvement.
  
  
  CONCLUSIONS
  Lower urinary tract symptoms may progress or remit. Even accounting for medication use, progression may be associated with modifiable disease, or metabolic or behavioral factors, which are also risk factors for type 2 diabetes and cardiovascular disease. These factors should be looked for and managed.
authors.affiliation: Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; School of Medicine, University of Adelaide, Adelaide, South Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Martin
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, South Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Lange
authors.affiliation: Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Haren
authors.affiliation: SANSOM Institute, Division of Health Sciences, University of South Australia, Adelaide, South Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; School of Medicine, University of Adelaide, Adelaide, South Australia. Electronic address: gary.wittert@adelaide.edu.au.
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D018450:Disease Progression; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
keywords: BPH; CV; HDL; LUTS; OSA; benign prostatic hyperplasia; coefficient of variance; cohort studies; epidemiology; high-density lipoprotein; lower urinary tract symptoms; men’s health; obstructive sleep apnea; prostatism; urinary tract physiological phenomena