As we know, urinary problems are closely associated with benign prostate enlargement and of course, prostate cancer, and can be quite serious in terms of physical discomfort, personal inconvenience and embarrassment. The following article is therefor relevant to most readers, particularly the older chaps, as it throws an apparent new risk factor into the picture.

AUA: Urinary Symptoms in Older Men Linked to Increased Fall Risk
By Charles Bankhead, Staff Writer, MedPage Today
Published: May 22, 2008
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

ORLANDO, May 22 — Lower urinary tract symptoms significantly increase the risk of falls in older men, a large prospective cohort study suggested.

Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Both moderate and severe symptoms independently influenced the risk of falls, J. Kellogg Parsons, M.D., of the University of California San Diego, reported at the American Urological Association meeting here. Falls were most closely associated with urgency, straining to start urination, and nocturia.

“These results may justify routine assessment of urinary symptoms in primary care,” Dr. Parsons concluded.

Lower urinary tract symptoms affect 15% to 60% of men age 40 and older, and the prevalence increases with age. Falls also become more prevalent with age, and 25% of men older than 65 have one or more falls each year, Dr. Parsons noted.

Symptoms, particularly nocturia and incontinence, have been postulated to increase the risk of falls, but the association had not been studied in detail, he continued. The Osteoporotic Fractures in Men (MrOS) study afforded a chance to examine the link between LUTS and falls in a large group of community-dwelling men.

Dr. Parsons and colleagues analyzed data on 5,872 MrOS participants, all 65 or older. Baseline information included the prevalence of lower urinary tract symptoms, as defined by the AUA Symptom Index: mild, 0-7; moderate, 8-19; and severe, 20+. Stratification by symptom score showed that 54% of the men had mild symptoms, 39% had moderate symptoms, and 7% severe.

Overall, 1,231 men (21%) reported falling at least once in the previous 12 months. The risk of falls increased significantly with age (P0.0001) and with symptom severity (P0.0001):

Mild, 18%
Moderate, 24%
Severe, 28%

The risk of one or more falls was significantly increased in men with moderate (OR 1.11, 95% CI 1.01 to 1.22) or severe symptoms (OR 1.33, 95% CI 1.15 to 1.53). Among men reporting two or more falls in the previous year, the association with lower urinary tract symptoms was even stronger: OR 1.21, 95% CI 1.05 to 1.40 for moderate symptoms and OR 1.63, 95% CI 1.31 to 2.02 for severe symptoms.

Increased frequency of urgency, straining to initiate urination, and nocturia were associated with the risk of any fall but even more so with the risk of two or more falls:

Urgency (OR 1.59, 95% CI: 1.33 to 1.89)
Straining (OR 1.60. 95% CI: 1.27 to 2.02)
Nocturia (OR 1.42, 95% CI: 1.16 to 1.74)

Dr. Parsons reported no disclosures.

Primary source: Journal of Urology
Source reference:
Parsons JK, et al “Lower urinary tract symptoms and the risk of falls in older men” J Urol 2008; 179(suppl): 140; Abstract 394.

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