TAMPERE, Finland — Heading to the bathroom more often in the evening is a simple fact of life for many older adults. However, new research suggests that even less bothersome urinary issues may signal a greater overall mortality risk for men over the age of 50.
Researchers in Finland have found that moderate to severe lower urinary tract symptoms (LUTS) in older men have a connection to an increased risk of dying. Troublingly, researchers say some of these associations held true even if patients weren’t all that bothered by their urinary troubles.
“This indicates the importance of assessing the general health, risk factors, and major comorbidities among men with LUTS,” the study authors write in a media release.
Led by Jonne Åkerla, MD, of Tampere University, Finland, this project made use of data originally collected for a long-term follow-up study focusing on male health. The research team analyzed lower urinary tract symptoms among over 3,000 Finnish men who had been in their 50s, 60s, and 70s back in 1994. Study authors tracked many of those participants (1,167 men) until the end of 2018. Nearly half passed away during the entire 24-year follow-up period.
Study authors focused specifically on lower urinary tract symptoms as a death risk factor during the tracking period, all while adjusting for age and various additional medical conditions (co-morbidities). Notably, that analysis also accounted for possible interactions between symptoms and “bothersomeness.”
‘Coping’ isn’t always a good plan
Bothersomeness may seem like an odd metric to focus on, but for urologists, whether or not patients “are bothered by” their urinary troubles is a big consideration. For instance, urologists generally believe men who say their urinary symptoms don’t bother them often are “successfully coping” with the condition. In this case, doctors don’t usually recommend treatment or surgery.
Furthermore, the study reveals numerous significant associations between male urinary tract symptoms and long-term mortality risk. Researchers observed a 20-percent increased mortality risk among men diagnosed with moderate to severe bladder emptying or “voiding” symptoms (urinary hesitancy, weak stream, straining). Also, the team found a 40-percent surge in death risk among men with “storage” problems (frequently peeing all day and night, or various types of incontinence).
Notably, however, an analysis including mild urinary symptoms found no mortality risk increases.
“For clinicians, the analyses show that moderate and severe male LUTS in general are good indicators of poor health whereas mild LUTS can be considered as a normal part of healthy aging,” study authors write.
Daytime urination a major sign of longevity?
There were, however, a few notable exceptions to this general trend. Regardless of symptom severity, men dealing with frequent daytime urination saw their death risk jump by 30 percent, and those with nocturia (frequent nighttime urination) experienced a 50-percent increase.
“This suggests considering daytime voiding interval of three or less hours and any nighttime voiding as patient-important, especially when appearing as persistent symptoms,” researchers write.
Moreover, death risk more than doubled among men with frequent urinary incontinence. This “particularly strong” association suggests, according to researchers, that urinary urgency holds significant sway over health and functional status in older men. It’s possible this has a connection to the effects of long-term neurological and vascular disease.
In conclusion, study authors wonder if depending so heavily on subjective “bothersomeness” is the best approach to male urinary health in old age.
“The lack of association between symptom bother and mortality possibly reinforces the very subjective nature of bother as a construct compared to more objectively measured symptom severity,” Dr. Åkerla and colleagues conclude.
The study is published in the Journal of Urology.