title: Is there room for behavioral and modifiable health-related targets in the lower urinary tract symptoms' scenario.
abstract: OBJECTIVE
  To better understand potential modifiable risk factors guiding preventive interventions against lower urinary tract symptoms (LUTS).
  
  
  METHODS
  A prospective cross-sectional study, including healthy men aged 40-70 years under routine urological evaluation, measured the strength of association between the International Prostate Symptom Score (IPSS) and socio-demographic, lifestyle, and health-related factors using logistic and linear regression adjusted for confounding factors. Men with urethral or prostate surgery were excluded.
  
  
  RESULTS
  Among 743 men, mean age 59.64 ± 9.66, 22.6% reported moderate, and 5.0% severe LUTS. The adjusted odds of severe LUTS increased with: increasing age (OR = 1.07, 95% CI = 1.05-1.09, p < .0001), increasing prostate volume (OR = 1.02, 95% CI = 1.01-1.04, p = .004), decreasing education (tertiary qualification, no versus yes, OR = 2.34; 95% CI = 1.16-4.70; p = .0133), delayed ejaculation (yes versus no, OR = 2.63, 95% CI = 1.43-4.83, p < .0001), and increasing blood pressure (systolic ≥130 mmHg, OR = 2.03, 95% CI = 1.44-2.86, p < .0001 or diastolic ≥85 mmHg, OR = 1.47, 95% CI = 1.03-2.10, p = .0345); severe LUTS decreased with: increasing the weekly sexual frequency (OR = 0.80, 95% CI = 0.69-0.91, p = .0012) and increasing HDL cholesterol (OR = 0.98, 95% CI = 0.97-0.99, p = .037). Odds were not significant for age of sexual initiation, precocious ejaculation, masturbatory pattern, physical activity, smoking, alcohol consumption, penile length (objective and subjective), abdominal circumference, obesity, comorbid conditions, metabolic syndrome, serum glycaemia, testosterone, SHBG, PSA, and estradiol.
  
  
  CONCLUSIONS
  One in every four men under routine urological evaluation who considered themselves healthy present moderate and severe LUTS. Modifiable behavioral (education, sexual frequency, and ejaculation) and health-related (blood pressure and HDL cholesterol) targets were identified for future interventional studies and potential preventive actions and patient counseling.
authors.affiliation: University of Campinas, Unicamp, São Paulo, Brazil.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikari
authors.affiliation: University of Campinas, Unicamp, São Paulo, Brazil.
authors.forename: Brunno C F
authors.initials: BCF
authors.lastname: Sanches
authors.affiliation: Paulínia Municipal Hospital, São Paulo, Brazil.
authors.forename: João Carlos Cardoso
authors.initials: JCC
authors.lastname: Alonso
authors.affiliation: Paulínia Municipal Hospital, São Paulo, Brazil.
authors.forename: Fabiano A
authors.initials: FA
authors.lastname: Simões
authors.affiliation: Paulínia Municipal Hospital, São Paulo, Brazil.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Rejowski
authors.affiliation: Paulínia Municipal Hospital, São Paulo, Brazil.
authors.forename: Walker Wendel
authors.initials: WW
authors.lastname: Laranja
authors.affiliation: Urologic Oncology, Faculty of Medicine, Center for Life Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, São Paulo, Brazil. reisleo.l@gmail.com.|University of Campinas, Unicamp, São Paulo, Brazil. reisleo.l@gmail.com.|Paulínia Municipal Hospital, São Paulo, Brazil. reisleo.l@gmail.com.
authors.forename: Leonardo O
authors.initials: LO
authors.lastname: Reis
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D008076:Cholesterol, HDL / Q000378:metabolism*; D003430:Cross-Sectional Studies; D004522:Educational Status; D004542:Ejaculation; D004958:Estradiol / Q000378:metabolism; D015444:Exercise; D006801:Humans; D007610:Kallikreins / Q000378:metabolism; D016014:Linear Models; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000378:metabolism; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D009929:Organ Size; D010413:Penis / Q000033:anatomy & histology; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000378:metabolism; D012307:Risk Factors; D012720:Severity of Illness Index; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D013739:Testosterone / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Chronic pelvic ischemia syndrome; IPSS; Risk factor; Voiding