Association Between Lower Urinary Tract Symptoms and Frailty in Older Men Presenting for Urologic Care

Bladder Cancer

Urology. 2020 Oct 10:S0090-4295(20)31249-8. doi: 10.1016/j.urology.2020.09.041. Online ahead of print.


OBJECTIVES: To evaluate the association between non-neurogenic lower urinary tract symptoms (LUTS) and frailty among treatment-seeking older men.

METHODS: This is a cross-sectional study of male patients age 65 years and older presenting to an academic urology practice between December 2015 and March 2019. Men with cancer, neurologic disease, indwelling catheter, or continuous leakage were excluded. Participants completed a Timed-Up-and-Go-Test (TUGT) which was used to categorize men as fast (≤10s), intermediate (11-14s), or slow (≥15s). Participants with the following diagnoses were identified using billing codes extracted from the electronic medical record: overactive bladder (OAB), benign prostatic hyperplasia (BPH), mixed OAB/BPH, or non-LUTS urologic condition. Multivariable associations were evaluated using multinomial logistic regression models adjusted for age, race, and BMI.

RESULTS: Among 2206 men included in our sample, 64% were fast (mean TUGT time: 8.3±1.2 seconds), 25% were intermediate (mean TUGT time: 12.0±1.0 seconds), and 11% were slow (mean TUGT time: 18.5±4.7 seconds). Subjects with slow TUGT times were more likely to be older, non-White, and have LUTS. Compared to non-LUTS conditions, OAB (odds ratio (OR)=2.62, 95% CI 1.74, 3.93), BPH (OR=1.70, 95% 1.14, 2.55), and mixed OAB/BPH (OR=1.82, 95% 1.14, 2.92) were all associated with increased odds of slow TUGT time. LUTS diagnosis was not significantly associated with intermediate TUGT time.

CONCLUSIONS: LUTS diagnosis, particularly OAB, is associated with increased odds of slow TUGT time, a surrogate of frailty, compared to non-LUTS conditions. Frailty is common among older men with LUTS and should be considered during the initial urological evaluation.