CHANGES IN DISEASE SPECIFIC AND GENERIC QUALITY OF LIFE RELATED TO CHANGES IN LOWER URINARY TRACT SYMPTOMS: THE KRIMPEN STUDY ESTHER T. KOK,* ARTHUR M. BOHNEN,† FRANS P. M. J. GROENEVELD, JAN J. V. BUSSCHBACH, MARCO H. BLANKER AND J. L. H. RUUD BOSCH‡ From the Departments of General Practice (ETK, AMB, FPMJG, MHB) and Medical Psychology and Psychotherapy (JJVB), Erasmus Medical Center, Rotterdam and Department of Urology, University Medical Center Utrecht (JLHRB), Utrecht, The Netherlands ABSTRACT Purpose: We determined if and to what extent longitudinal changes in lower urinary tract symptoms are related to disease specific and generic quality of life in men. Material and Methods: A longitudinal, population based study with a followup of 4.2 years was done in 1,688 who were 50 to 79 years old. Data were collected through self-administered questionnaires, including the Sickness Impact Profile (3 domains), Inventory of Subjective Health, International Prostate Symptom Score (I-PSS) and Benign Prostatic Hyperplasia Impact Index. Moreover, they completed various physical and urological measurements. Mean I-PSS and quality of life scores at baseline and followup were analyzed for certain subgroups. Multiple linear regression was used to determine the change in quality of life in relation to baseline I-PSS, I-PSS changes between baseline and followup, and age. Results: Although mean I-PSS increased with time, the average generic quality of life improved and almost a third of the men reported better disease specific quality of life. Multiple linear regression revealed that disease specific quality of life was associated with I-PSS at baseline, changes in I-PSS between baseline and followup, and age. However, generic quality of life scores were not associated with these parameters. Conclusions: Changes in lower urinary tract symptoms severity had little impact on disease specific quality of life in 50 to 79-year-old men or on generic quality of life during the 4.2-year followup. KEY WORDS: urinary tract, urination disorders, quality of life, questionnaires, aging Due to population aging and the availability of new, min- imally invasive treatments increasing attention is being given to the impact of lower urinary tract symptoms (LUTS) on quality of life (QOL). In LUTS symptom severity has been reported to have a significant impact on physical and social functioning, mental health, and the perception of health and general well-being. 1-7 The severity of LUTS, measured as the frequency of symptoms rated by the patient, and bother, as experienced by the patient, are important determinants for intervention. Since the presence of symptoms does not necessarily reflect the experience of them, the concept of QOL as a consequence of LUTS is of interest. Data on the relationship between LUTS severity and QOL is largely based on cross-sectional studies. 2-6 Because LUTS likely is to be associated with other morbidity, it follows that the relationship between LUTS and QOL may be confounded by such comorbidity. This methodological problem can in part be overcome by measuring the relationship between the change with time in LUTS and in QOL. However, few studies have examined the relationship between long-term changes in LUTS severity and changes in QOL scores with time. 1, 8, 9 Therefore, in this longitudinal study we determined if and to what extent changes in LUTS are related to changes in QOL. MATERIALS AND METHODS The Krimpen Study is an ongoing, longitudinal, community based population study of 50 to 75-year-old men, in which the natural history of LUTS and its relationship to general well- being was surveyed. After baseline evaluation 2 followup rounds were completed. The design of the Krimpen Study has been extensively described previously. 10 Briefly, all 3,924 eligi- ble men 50 to 75 years old in Krimpen aan den IJssel were invited to participate, of whom 50% responded. All men pro- vided written informed consent. The Medical Ethics Committee of Erasmus Medical Centre Rotterdam approved the study. Participants completed a questionnaire, including the short version of the Inventory of Subjective Health (Mini- ISH), 3 domains of the Sickness Impact Profile (SIP), the International Prostate Symptom Score (I-PSS) and the be- nign prostatic hyperplasia Impact Index (BII). Moreover, they underwent various physical and urological meas- urements. Based on the results of digital rectal examination and prostate specific antigen prostate biopsies were done to exclude prostate cancer. If no prostate cancer was detected, participants had not moved outside of the municipality, they were alive and no exclusion criteria were met, a re-invitation letter was mailed to all participants for followup. Two consecutive rounds of fol- lowup were performed with an average followup of 2.1 and 4.2 years, respectively. In these rounds all measurements were repeated. QOL questionnaires. Generic measurements are commonly used to measure changes in QOL due to a disease or treat- ment in terms that are applicable to every individual irre- Submitted for publication October 28, 2004. Study received Medical Ethics Committee, Erasmus Medical Cen- tre Rotterdam approval. * Correspondence: Department of General Practice, Erasmus Medical Center, P. O. Box 1738, 3000 DR Rotterdam, The Netherlands (telephone: 31–10-4087629; FAX: 31–10-4632127; e-mail: e.vanderwerf-kok@ erasmusmc.nl). † Financial interest and/or other relationship with GlaxoSmithKline and Pfizer. ‡ Financial interest and/or other relationship with GlaxoSmithKline. 0022-5347/05/1743-1055/0 Vol. 174, 1055–1058, September 2005 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000169256.74421.e5 1055