Lifestyle and Health Factors Associated with Progressing and Remitting Trajectories of Untreated Lower Urinary Tract Symptoms among Elderly Men

BACKGROUND: Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission. METHODS: In community dwelling U.S. men age ≥ 65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000–2002) and then every two years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or benign prostatic hyperplasia (BPH) during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modeling of the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared to stable trajectories, and with remitting compared to progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history, and prescription medications were considered for selection. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for variables in each model. RESULTS: We identified 10 AUA-SI trajectories: four stable (1 277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%), and one mixed (20 men, 1%). Men in progressing compared to stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0–3.8), poor mental health (OR=1.9, 95% CI: 1.1–3.4), BMI ≥ 25.0 kg/m(2) (OR=1.7, 95% CI: 1.0–2.8), hypertension (OR=1.5, 95% CI: 1.0–2.4), and back pain (OR=1.5, 95% CI: 1.0–2.4). Men in remitting compared to progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1–4.9) and less often had a history of problem drinking (OR=0.4. 95% CI: 0.2–0.9). CONCLUSIONS: Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.