Korean J Urol.  2014 May;55(5):300-308. 10.4111/kju.2014.55.5.300.

Epidemiology of Lower Urinary Tract Symptoms: Emphasis on the Status in Korea

• Lee H
• Jeong SJ

• KMID: 1988406
• DOI: http://doi.org/10.4111/kju.2014.55.5.300

Abstract

A comprehensive and correct understanding of epidemiologic finding about lower urinary tract symptoms (LUTS) is important for several reasons. First, LUTS are highly prevalent in both genders all around the world and are expected to be a major concern to physicians in the near future because of the rapid rise in the elderly population. Second, it is crucial to observe trends in prevalence when national health care policy is established. By using a Medline search with various terms related to LUTS and prevalence, a review of epidemiologic studies was undertaken with an emphasis on the status in Korea. Despite the suggestions made by the International Continence Society, the lack of uniform definitions and the lack of a unified threshold of symptoms are the biggest obstacles in epidemiologic study with regard to LUTS. Most Korean epidemiologic studies on LUTS have been reported since 2000 and reveal that the prevalences of specific clinical conditions, such as LUTS, benign prostatic hyperplasia, overactive bladder, and detrusor underactivity, are in line with prevalences in Western counties. However, the prevalence of nocturia is somewhat different from that in Western countries. Many epidemiologic studies of LUTS have provided us with valuable information and a better understanding of the clinical conditions. Given that the impact of these clinical conditions on quality of life and health care cost will be emphasized more in the near future, more studies on optimal management approaches to LUTS are needed on the basis of this knowledge.

Keyword

Epidemiology; Korea; Lower urinary tract symptoms; Urinary bladder

MeSH Terms

Aged
Delivery of Health Care
Epidemiologic Studies
Epidemiology*
Health Care Costs
Humans
Korea
Lower Urinary Tract Symptoms*
Nocturia
Prevalence
Prostatic Hyperplasia
Quality of Life
Urinary Bladder
Urinary Bladder, Overactive

Reference

1. United Nations Population Division. World population ageing 1950-2050. New York: United Nations Publications;2001.

2. Korea National Statistical Office. 2006 Statistics on the aged [Internet]. Daejeon: Korea National Statistical Office;c2014. cited 2014 Feb 2. Available from: http://kostat.go.kr/portal/english/news/1/8/index.board?bmode=read&bSeq=&aSeq=67162&pageNo=3&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt=2006.

3. Irwin DE, Milsom I, Kopp Z, Abrams P, Artibani W, Herschorn S. Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of overactive bladder. Eur Urol. 2009; 56:14–20.

4. Cochran WG. Sampling techniques. 3rd ed. New York: Wiley;1977.

5. Groves RM, Biemer PP, Lyberg LE, Massey JT, Nocholls WL II, Waksberg J. Telephone survey methodology. New York: Wiley;1988.

6. Coyne KS, Sexton CC, Kopp ZS, Luks S, Gross A, Irwin D, et al. Rationale for the study methods and design of the epidemiology of lower urinary tract symptoms (EpiLUTS) study. BJU Int. 2009; 104:348–351.

7. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009; 104:352–360.

8. Couper M. Web surveys: a review of issues and approaches. Public Opin Q. 2000; 64:464–494.

9. Groves RM. Survey errors and survey costs. New York: Wiley;2004.

10. Abrams P. New words for old: lower urinary tract symptoms for "prostatism". BMJ. 1994; 308:929–930.

11. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21:167–178.

12. Girman CJ, Epstein RS, Jacobsen SJ, Guess HA, Panser LA, Oesterling JE, et al. Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men. Urology. 1994; 44:825–831.

13. Temml C, Brossner C, Schatzl G, Ponholzer A, Knoepp L, Madersbacher S, et al. The natural history of lower urinary tract symptoms over five years. Eur Urol. 2003; 43:374–380.

14. Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, et al. The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003; 92:409–414.

15. Sarma AV, McLaughlin JC, Jacobsen SJ, Logie J, Dolin P, Dunn RL, et al. Longitudinal changes in lower urinary tract symptoms among a cohort of black American men: the Flint Men's Health Study. Urology. 2004; 64:959–965.

16. Seim A, Hoyo C, Ostbye T, Vatten L. The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT study. BJU Int. 2005; 96:88–92.

17. Taylor BC, Wilt TJ, Fink HA, Lambert LC, Marshall LM, Hoffman AR, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006; 68:804–809.

18. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006; 50:1306–1314.

19. Moreira ED Jr, Neves RC, Neto AF, Duarte FG, Moreira TL, Lobo CF, et al. A population-based survey of lower urinary tract symptoms (LUTS) and symptom-specific bother: results from the Brazilian LUTS epidemiology study (BLUES). World J Urol. 2013; 31:1451–1458.

20. Lee YS, Lee KS, Jung JH, Han DH, Oh SJ, Seo JT, et al. Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study. World J Urol. 2011; 29:185–190.

21. Lee E, Yoo KY, Kim Y, Shin Y, Lee C. Prevalence of lower urinary tract symptoms in Korean men in a community-based study. Eur Urol. 1998; 33:17–21.

22. Cho KS, Jo MK, Lim D, Son H, Park SK, Yoo KY, et al. Epidemiologic Survey Using International Prostate Symptom Score (I-PSS) of Lower Urinary Tract Symptoms (LUTS) in Elderly Men Above 40 Years Old in Seoul Area. Korean J Urol. 2001; 42:840–848.

23. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984; 132:474–479.

24. Sagnier PP, MacFarlane G, Richard F, Botto H, Teillac P, Boyle P. Results of an epidemiological survey using a modified American Urological Association symptom index for benign prostatic hyperplasia in France. J Urol. 1994; 151:1266–1270.

25. Lee E, Park MS, Shin C, Lee H, Yoo K, Kim Y, et al. A high-risk group for prostatism: a population-based epidemiological study in Korea. Br J Urol. 1997; 79:736–741.

26. Hald T. Urodynamics in benign prostatic hyperplasia: a survey. Prostate Suppl. 1989; 2:69–77.

27. Garraway WM, Collins GN, Lee RJ. High prevalence of benign prostatic hypertrophy in the community. Lancet. 1991; 338:469–471.

28. Safarinejad MR. Prevalence of benign prostatic hyperplasia in a population-based study in Iranian men 40 years old or older. Int Urol Nephrol. 2008; 40:921–931.

29. Chicharro-Molero JA, Burgos-Rodriguez R, Sanchez-Cruz JJ, del Rosal-Samaniego JM, Rodero-Carcia P, Rodriguez-Vallejo JM. Prevalence of benign prostatic hyperplasia in Spanish men 40 years old or older. J Urol. 1998; 159:878–882.

30. Blanker MH, Groeneveld FP, Prins A, Bernsen RM, Bohnen AM, Bosch JL. Strong effects of definition and nonresponse bias on prevalence rates of clinical benign prostatic hyperplasia: the Krimpen study of male urogenital tract problems and general health status. BJU Int. 2000; 85:665–671.

31. Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, et al. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care: the Triumph project. Eur Urol. 2002; 42:323–328.

32. Rhew HY, Koo JH, Cho SS, Kang JS, Lee CK, Kim JC, et al. The prevalence of BPH in Busan city over age 40. Korean J Urol. 2001; 42:223–227.

33. Park HK, Park H, Cho SY, Bae J, Jeong SJ, Hong SK, et al. The prevalence of benign prostatic hyperplasia in elderly men in Korea: a community-based study. Korean J Urol. 2009; 50:843–847.

34. Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001; 87:760–766.

35. Homma Y, Yamaguchi O, Hayashi K. Neurogenic Bladder Society Committee. An epidemiological survey of overactive bladder symptoms in Japan. BJU Int. 2005; 96:1314–1318.

36. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003; 20:327–336.

37. Temml C, Heidler S, Ponholzer A, Madersbacher S. Prevalence of the overactive bladder syndrome by applying the International Continence Society definition. Eur Urol. 2005; 48:622–627.

38. Moorthy P, Lapitan MC, Quek PL, Lim PH. Prevalence of overactive bladder in Asian men: an epidemiological survey. BJU Int. 2004; 93:528–531.

39. Wang Y, Xu K, Hu H, Zhang X, Wang X, Na Y, et al. Prevalence, risk factors, and impact on health related quality of life of overactive bladder in China. Neurourol Urodyn. 2011; 30:1448–1455.

40. Chen YC, Ng SC, Chen SL, Huang YH, Hu SW, Chen GD. Overactive bladder in Taiwanese women: re-analysis of epidemiological database of community from 1999 to 2001. Neurourol Urodyn. 2012; 31:56–59.

41. Choo MS, Ku JH, Lee JB, Lee DH, Kim JC, Kim HJ, et al. Cross-cultural differences for adapting overactive bladder symptoms: results of an epidemiologic survey in Korea. World J Urol. 2007; 25:505–511.

42. Swithinbank LV, Abrams P. A detailed description, by age, of lower urinary tract symptoms in a group of community-dwelling women. BJU Int. 2000; 85:Suppl 2. 19–24.

43. Perry S, Shaw C, Assassa P, Dallosso H, Williams K, Brittain KR, et al. Leicestershire MRC Incontinence Study Team. An epidemiological study to establish the prevalence of urinary symptoms and felt need in the community: the Leicestershire MRC Incontinence Study. J Public Health Med. 2000; 22:427–434.

44. Kang D, Andriole GL, Van De, Crawford D, Chia D, Urban DA, et al. Risk behaviours and benign prostatic hyperplasia. BJU Int. 2004; 93:1241–1245.

45. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol. 2011; 185:571–577.

46. van Dijk L, Kooij DG, Schellevis FG. Nocturia in the Dutch adult population. BJU Int. 2002; 90:644–648.

47. Schatzl G, Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S. Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project. Urology. 2000; 56:71–75.

48. Muscatello DJ, Rissel C, Szonyi G. Urinary symptoms and incontinence in an urban community: prevalence and associated factors in older men and women. Intern Med J. 2001; 31:151–160.

49. Tikkinen KA, Auvinen A, Huhtala H, Tammela TL. Nocturia and obesity: a population-based study in Finland. Am J Epidemiol. 2006; 163:1003–1011.

50. Kageyama T, Kabuto M, Nitta H, Kurokawa Y, Taira K, Suzuki S, et al. Prevalence of nocturia among Japanese adults. Psychiatry Clin Neurosci. 2000; 54:299–300.

51. Choo MS, Ku JH, Park CH, Lee YS, Lee KS, Lee JG, et al. Prevalence of nocturia in a Korean population aged 40 to 89 years. Neurourol Urodyn. 2008; 27:60–64.

52. Lee YJ, Jeong SJ, Byun SS, Lee JJ, Han JW, Kim KW. Prevalence and correlates of nocturia in community-dwelling older men: results from the Korean longitudinal study on health and aging. Korean J Urol. 2012; 53:263–267.

53. Malone-Lee J, Wahedna I. Characterisation of detrusor contractile function in relation to old age. Br J Urol. 1993; 72:873–880.

54. van Mastrigt R. Age dependence of urinary bladder contractility. Neurourol Urodyn. 1992; 11:315–317.

55. Pfisterer MH, Griffiths DJ, Schaefer W, Resnick NM. The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc. 2006; 54:405–412.

56. Seki N, Kai N, Seguchi H, Takei M, Yamaguchi A, Naito S. Predictives regarding outcome after transurethral resection for prostatic adenoma associated with detrusor underactivity. Urology. 2006; 67:306–310.

57. Gateau T, Faramarzi-Roques R, Le Normand L, Glemain P, Buzelin JM, Ballanger P. Clinical and urodynamic repercussions after TVT procedure and how to diminish patient complaints. Eur Urol. 2003; 44:372–376.

58. Resnick NM, Yalla SV, Laurino E. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989; 320:1–7.

59. Abarbanel J, Marcus EL. Impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms. Urology. 2007; 69:436–440.

60. Lee JG, Shim KS, Koh SK. Incidence of detrusor underactivity in men with prostatism older than 50 years. Korean J Urol. 1999; 40:347–352.

61. Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, et al. Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J Urol. 2012; 53:342–348.

62. Valentini FA, Robain G, Marti BG, Nelson PP. Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis? Int Braz J Urol. 2010; 36:218–224.

63. Groutz A, Gordon D, Lessing JB, Wolman I, Jaffa A, David MP. Prevalence and characteristics of voiding difficulties in women: are subjective symptoms substantiated by objective urodynamic data? Urology. 1999; 54:268–272.

64. Ameda K, Sullivan MP, Bae RJ, Yalla SV. Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men. J Urol. 1999; 162:142–146.

65. Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014; 65:389–398.