Brirish JournuIo/ Urology (1990), 66, 175-176 0 I990 British Journal of Urology

0007Fl3il 90 0066 0175 $1000

Prevalence of Urinary Symptoms in Men Aged over 60

J. P. BRITTON, A. C. DOWELL and P. WHELAN

Departments of Urology and General Practice, St James's University Hospital, Leeds

Summary-The prevalence of urological symptoms in elderly males in the community is poorly documented. A series of 5 7 8 men, aged 60 to 85 years and registered with one inner city health centre, completed a self-administered questionnaire whiclh enquired about current urological symptoms. Many symptoms were common, including a lengthening of the time to pass ur ine (26%), a deterioration in urinary flow (30%)' dribbling (26%), urgency (31%), increased day-time frequency (32%) and nocturia (57%); 102 men (18%) gave 5 or more positive responses to the 1 3 questions relating to urological symptoms. In contrast, during a 2-year period, only 17 men, aged 60 to 85 years, were referred to a urology department from the same health centre. The implications of these findings are discussed.

In men, urinary symptoms become increasingly Results common with age. The prevalence of urinary incontinence in elderly males ranges from 6 to 19% (Feneley et al., 1979; Thomas et al., 1980; Diokno et al., 1986) but other equally troublesome symp- toms, such as urgency, frequency and nocturia, may be present in up to 50% (Milne et al., 1972).

We have investigated the prevalence of urinary

The prevalence of urinary symptoms is shown in Table 1. Many symptoms were common and nearly all shlowed an increased prevalence with age, although only urgency and nocturia reached statis- tical significance. The number of urological symp- toms reported by each patient is shown in Table 2 ;

symptoms in a group of elderly men registered with one inner city health centre, and compared this with the referral pattern to a urological department.

No. of men (%) Patients and Methods

Age (years) Age (yeurs j

330 (100%) 248 (100%) to attend a health screening clinic during 1988. w.1 1 2 W Those considered unfit toattend because ofterminal

disease, severe immobility or dementia were ex- Longer to pass urine 80(24) 68(27) 93(28) 83(33) cluded. The 578 men (68%) who did attend were

asked to complete a self-administered questionnaire Sit down to pass urine lO(3) 9(4) 7(2) 6 0 )

which had previously been validated in a combined ~ ~ ~ $ ? , ~ ~ ~ ~ ~ ~ ~ ~ ~ e n c e 83(25) 69(28) hospital/general practice study; it included ques- urgency 88(27) 92(37) P<O.O1 tions about past urological history and current Increased daytime frequency lOO(30) 84(34) urological symptoms. Nocturia x 1 172(52) 158(64) P<O.005

73(22) 73(29)

Table 1 Males

Prevalence of Urological Symptoms in 578

A total of 855 men, aged 60 to 85 years, were invited 60-69 70-85

passing urine

Slowingof urinary stream

2(1) 5 0 )

from health centre records. Recent loin pain 7 m 5 0 )

Details of hospital referrals for the 2-year period from January 1987 to December 1988 were obtained ~~('~~"~a~~~n~"?''ce

Recent or past dysuria 17(5) 8(3)

Tota!l 330 248 Accepted for publication 7 December 1989

175

176 BRITISH JOURNAL OF UROLOGY

Table 2 Urological Symptoms

102 patients (1 8%) gave 5 or more positive responses to the 13 questions.

Some patients had previously been told by a doctor that they had “bladder trouble” (673, urine infection (8%) or “prostate trouble” (1 1%); 40 patients (7%) had previously undergone prostatec- tomy (9 in the 60-69 year group, 31 in the 70-85 year group). The mean age at prostatectomy was 67 years (range 49-80).

In the 2-year period from January 1987 to December 1988, 17 men over the age of 60 years were referred to a urology department, a referral rate of less than 1% per annum. The mean age at time of referral was 73 years (range 61-80; 15 patients were referred with a provisional diagnosis of “prostatism”, 1 with recurrent urinary tract infections and 1 with frequency and nocturia.

Discussion

The results of this study showed that urinary symptoms were common in a group of relatively active men, aged 60 to 85 years, taken from an inner city community. All symptoms became more common with increasing age, particularly nocturia and urgency ; others included frequency, dribbling and a slowing of the urinary stream, with 18% of patients admitting to 5 or more symptoms.

Urinary incontinence, probably the most embar- rassing symptom, has been reported in up to 18% of men over the age of 60 (Feneley et al., 1979; Thomas et al., 1980; Diokno et al., 1986). We found a prevalence of 27%, although we used its most liberal definition, asking patients if “they ever dribble into their pants”. For many patients such incontinence may be inconsequential, but for others this distressing condition requires treatment.

Analysis of hospital referrals revealed that less than 1% of men over the age of 60 years were referred to a urology department each year.

The disquieting message is that the urologist sees

only a small fraction of the total problem and many more patients may be in need of further assessment and treatment.

Some men may not find their symptoms trouble- some and adapt their lifestyle accordingly and in some cases the symptoms may be transitory. Others may regard their symptoms as “part of the process of ageing” and thus not abnormal. Whether we should redefine “normal” for this group or whether we are failing to treat symptoms which would be amenable to medical or surgical therapy remains unknown. Further research is needed to investigate the clinical significance of these symptoms.

Acknowledgments We thank the Leeds FPC for supporting this project, the doctors and staff of Meanwood Group Practice for their co-operation and Sister Judith Mumford for administration of the question- naires.

References Diokno, A. C., Brock, B. M., Brown, M. B. et al. (1986).

Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalised elderly. J . Urol., 136,

Feneley, R. C. L., Shepherd, A. M., Powell, P. H. et al. (1979). Urinary incontinence: prevalence and needs. Br. J . Urol., 51, 493496.

Thomas,T. M., Plymat,K. R., Blannin, J. etal. (1980). Prevalence of urinary incontinence. Br. Med. J . , 281, 1243-1245.

Milne, J. S., Williamson, J., Maule, M. M. et al. (1972). Urinary symptoms in older people. Modern Geriatrics. 2 , 198-212.

1022-1025.

The Authors

of Urology.

Practice.

J. P. Britton, FRCS, Tutor and Honorary Registrar, Department

A. C. Dowell, MRCGP, Lecturer, Department of General

P. Whelan, MS, FRCS, Consultant Urologist.

Requests for reprints to: .I. P. Britton, Department of Urology, Guy’s Hospital, St Thomas Street, London SE1 9RT.