Urinary incontinence can plague men as they age, but a new study suggests it may be more than just a bothersome condition and might actually be a harbinger of early death.
"This indicates the importance of assessing the general health, risk factors and major co-morbidities among men with LUTS [lower urinary tract symptoms]," wrote the researchers, who were led by Jonne Akerla from the department of urology at Tampere University Hospital in Finland.
The team analyzed LUTS in more than 3,000 Finnish men who had enrolled in a study in 1994, when they were 50, 60 or 70. The research included a 24-year follow-up in 2018 of 1,167 of the men. About half had died during the intervening years.
The team looked at the men's lower urinary tract symptoms as a risk factor for death, adjusting for age and other medical conditions and considering whether the symptoms "bothered" the men.
In general, moderate and severe lower urinary tract symptoms were markers of poor health, according to the team.
Dr. Craig Comiter, a professor of urology at Stanford University School of Medicine in California, found the study intriguing, as prior studies have not shown a link between mortality and incontinence.
"The authors are to be lauded for their measured conclusions, hypothesizing that urinary symptoms are more of a marker of poor health than a direct cause of death," Comiter said. He described LUTS as any disorder that affects urinary storage, including excess urine production, incomplete bladder emptying, neurologic and myogenic (muscular) disorders of the bladder and benign prostate obstruction.
These urinary dysfunctions can be caused by a variety of common medical conditions, including heart disease or neurological conditions, diabetes, sleep disorder, restricted mobility, Parkinson's disease, dementia, stroke and multiple sclerosis.
In this study, men who had moderate to severe bladder-emptying symptoms (such as hesitancy, weak stream and straining) had a 20% increased risk of death during the study period. Those who had what are considered "storage" symptoms, such as frequent daytime urination, incontinence and nocturia (waking at night to urinate), had a 40% increased risk of death during the study.
Even for those in the study with mild symptoms, if they had daytime frequency, death risk was increased by 30%. If they had nocturia, death risk was increased by 50%.
Needing to urinate at night or more than every three hours in the daytime could be "patient-important," especially if persistent, the researchers said.
Frequent urinary incontinence had a particularly strong association with risk of death, which suggests that urinary urgency has a significant impact on health and functional status in aging men, the authors said, and may have been a reflection of long-term neurological or vascular disease.
The findings were published online recently in The Journal of Urology.
Dr. Anthony Schaeffer, a professor of urology at Northwestern University Feinberg School of Medicine in Chicago, said he thinks the results may be statistically significant, but not clinically significant.
"There's a light increase in mortality, but co-morbidities [other health conditions] exist in those men," Schaeffer said.
"What do you do about it? What you do about it is what we all do, we treat these folks," he said.
Schaeffer said there is no evidence that treating people for LUTS improves their life expectancy.
LUTS is typically diagnosed by symptoms, and doctors treat them with a variety of options under American Urological Association guidelines, Schaeffer said, including medication and surgery.
He pointed out that randomized controlled trials (the gold-standard for research) would be necessary to show that treating LUTS lowers your risk of early death.
No prior studies have linked incontinence to death, said Comiter, adding that the fact that this study shows urgency incontinence and premature death may in fact be related is important.
"Further research must investigate the role of 'restricted mobility' as a link between frailty and incontinence, as such restricted mobility may be the factor that transforms frequent and urgent urination into frank incontinence," Comiter said. "Furthermore, studies on younger populations are vital to see if there is a true causative link between urinary symptoms and mortality or if it [is] simply a marker of poor health in the elderly."
The U.S. National Library of Medicine has more on lower urinary tract symptoms in men.
SOURCES: Craig Comiter, MD, professor of urology and professor of obstetrics & gynecology (by courtesy), Stanford University College of Medicine, Stanford, Calif.; Anthony Schaeffer, MD, professor of urology, Northwestern University Feinberg School of Medicine, Chicago; The Journal of Urology, April 26, 2022, online