Identifying the predictors of change in severity of untreated lower urinary tract symptoms (LUTS) in men: a systematic review

Abstract

Background: Lower urinary tract symptoms (LUTS) fluctuate in severity. Factors that influence the change in symptomatology are a key area of interest, and knowledge of these may provide the opportunity for both primary prevention of LUTS and secondary prevention of worsening LUTS. Objective: The objective of this systematic review was to synthesise the available evidence assessing the predictors of change in the severity of untreated LUTS in men in a non-hospital setting. Method: Studies that included human males aged > 18 years of age in a non-hospital setting with untreated LUTS were considered for this review. A comprehensive search strategy was designed to find both published and unpublished studies that examined individual exposures and their influence on LUTS severity. Databases searched included PubMed, Embase, Scopus, Web of Science, Grey Literature Report and DIVA Academic Archive Online. Results: Twelve studies were included in this systematic review. The total number of men with untreated LUTS examined was 16,105. The mean age of men ranged from 49.7 to 72.7 years. The duration of follow-up ranged from 3-17 years. Heterogeneity within the study methodology, patient groups and outcome measures prevented the conduct of a meta-analysis. Fourteen grouped modifiable exposures and three non-modifiable exposures were examined that indicated that psychological health, cardiovascular risk factors, hormone status and some medications may influence the natural history of LUTS. Conclusion: Lower urinary tract symptoms are influenced by factors outside the urological system. Systemic diseases, hormonal status and some medications appear to be associated with fluctuations in LUTS. A causative relationship is still hypothesised, rather than proven, as is the potential role of intervening on modifiable factors.