Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored.

To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline.

Multicenter, prospective cohort study.

Population-based.

Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study.

Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0–5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1 Wei JT, Calhoun E, Jacobsen SJ Urologic diseases in america project: benign prostatic hyperplasia The Journal of urology 2008 ;  179 (5Suppl) : S75-S80 PubMed PMID: 18405761.

Cliquez ici pour aller à la section Références–2 Taylor BC, Wilt TJ, Fink HA , et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study Urology 2006 ;  68 (4) : 804-809 PubMed PMID: 17070357.  [inter-ref]

Cliquez ici pour aller à la section Références), or frail (3 Abrams P, Cardozo L, Fall M , et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society Urology 2003 ;  61 (1) : 37-49 PubMed PMID: 12559262.  [inter-ref]

Cliquez ici pour aller à la section Références–5 Noguchi N, Chan L, Cumming RG, Blyth FM, Naganathan V A systematic review of the association between lower urinary tract symptoms and falls, injuries, and fractures in community-dwelling older men The aging male: the official journal of the International Society for the Study of the Aging Male 2016 ;  19 (3) : 168-174 PubMed PMID: 27068237.  [cross-ref]

Cliquez ici pour aller à la section Références). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0–35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI.

Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing nonlinearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria.

Greater phenotypic frailty was associated with nonlinear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.