Testosterone Deficiency Linked to Lower Urinary Tract Symptoms

Over the past decade, it has become clear many of the age-related health problems of men, that have hitherto been treated using different medical disciplines, are actually inter-related and require a more integrative approach in the aging male. Lower urinary tract symptoms (LUTS) may serve as an example. LUTS consists of storage, voiding, and post micturition symptoms affecting the lower urinary tract. Storage symptoms (daytime frequency, nocturia, urgency, incontinence) are experienced during the storage phase of the bladder. Voiding symptoms (weak stream, splitting or spraying, abdominal straining, hesitancy, intermittency, terminal dribble) are experienced during the voiding phase. Post-micturition symptoms (feeling of incomplete emptying, post micturition dribble) are experienced immediately after micturition. Individuals with LUTS often experience urinary incontinence (UI) or overactive bladder (OAB) symptoms. OAB is a subset of storage LUTS defined as urgency, with or without urgency UI, usually with frequency and nocturia. Men may report one or any combination of the symptoms and LUTS, including UI and OAB, have detrimental effects on health-related quality of life. The prevalence of LUTS increases from 8% in the fourth decade of life to more than 70% in the seventh decade. In a large population-based cross-sectional survey the prevalence of storage LUTS (men, 51.3%; women, 59.2%) was greater than that for voiding (men, 25.7%; women, 19.5%) and post micturition (men, 16.9%; women, 14.2%) symptoms combined (Irwin et al., 2008). Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating. LUTS may point to serious pathology of the urogenital tract but are often nonspecific and large studies of patients have failed to show any correlation between LUTS and a specific diagnosis. An allencompassing view of LUTS that focuses on the lower urinary tract as an integrated functional unit, but simultaneously reflects pathophysiology in the body as a whole, is more likely to improve a clinician’s ability to manage the symptoms and therefore improve patient outcomes. Benign prostatic hyperplasia (BPH), which occurs more frequently with aging, is the most common cause of LUTS in middle-aged and elderly men, although many other diseases such as detrusor muscle weakness and/or instability, urinary tract infection, chronic prostatitis, urinary stone, prostate cancer, bladder cancer, neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome, and cardiac and renal diseases may accompany LUTS.