Prostatic Diseases and Male Voiding Dysfunction Natural Course of Lower Urinary Tract Symptoms in Men Not Requiring Treatment e A 5-Year Longitudinal Population-based Study Antti P€ oyh€ onen, Jukka T. H€ akkinen, Juha Koskim€ aki, Teuvo L. J. Tammela, and Anssi Auvinen OBJECTIVE To evaluate the natural course of lower urinary tract symptoms (LUTS) by quantifying their longitudinal changes. METHODS A population-based study of men aged 55, 65, or 75 years in Pirkanmaa region, Finland was conducted with a 5-year follow-up (1999-2004). Mailed self-administered questionnaire with the Danish Prostatic Symptom Score instrument was used to evaluate LUTS. Men with any treat- ment for LUTS or a history of prostate cancer were excluded. RESULTS A total of 1331 men were included in the study. All 12 symptoms exhibited considerable fluc- tuation over time. Incidence of specific symptoms varied by a factor of 10 and remission by a factor of 4. Overall, common symptoms varied most strongly in terms of incidence and remission, whereas the less common ones such as incontinence behaved in a more stable fashion. Remission was more frequent than incidence for all individual LUTS components. The highest incidence was found for post-micturition symptoms and urgency. Remission was most common in weak stream and least frequent in urgency and urgency incontinence. CONCLUSION LUTS are dynamic conditions with strong spontaneous fluctuation over time. Remission was more common than incidence. The strong propensity for spontaneous resolution should also be borne in mind in treatment decisions including prescription practices. UROLOGY 83: 411e415, 2014. Ó 2014 Elsevier Inc. L ower urinary tract symptoms (LUTS) are highly prevalent conditions in all populations, and the number of affected individuals is projected to increase with aging populations. 1 Numerous studies have reported widely varying estimates of the prevalence of LUTS. 2-5 The wide variations might be partly attribut- able to differences in study protocols and characteristics of study populations. Furthermore, some variation in symptom prevalence might be because of temporary recovery of underlying pathologic processes such as prostatitis/pelvic pain syndrome spontaneously or because of changes in lifestyle or environmental factors. Symptoms in benign prostate hyperplasia (BPH) probably vary also, especially in the early phase. 6 Such spontaneous recuperation in symptom intensity is reflected in fluctu- ation of prevalence of LUTS in longitudinal studies. 7 For better understanding of the etiology and patho- genesis of LUTS, natural history of symptoms in the absence of treatment should be characterized. This requires longitudinal studies with data on symptom inci- dence, as it cannot be evaluated in cross-sectional studies. Few representative follow-up studies with low attrition have been conducted, which is an impediment to comprehension of the natural history of LUTS. 8-13 In clinical practice, medical treatment for LUTS is widely used. Men complaining of symptomatic uncom- plicated BPH or bladder overactivity are usually treated with oral medication. Long-term medical treatment for LUTS is a therapeutic mainstay. Understanding the natural course of the symptoms is needed to assess treat- ment response and define appropriate indications for LUTS medication, to avoid over- and under-treatment. The aim of the study was to provide quantitative estimates of the natural course of LUTS in terms Financial Disclosure: The authors declare that they have no relevant financial interests. Funding Support: The work of Antti P€ oyh€ onen was supported by a grant from the Finnish Urological Association. From the Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland; the Hatanp€ a€ a Hospital, Tampere, Finland; the School of Health Sciences, University of Tampere, Tampere, Finland; and the Central Finland Central Hospital, Jyv€ askyl€ a, Finland Reprint requests: Antti P€ oyh€ onen, Department of Urology, Central Finland Central Hospital, Keskussairaalantie 19, Jyv€ askyl€ a FI-40620, Finland. E-mail: antti.j. poyhonen@gmail.com Submitted: June 7, 2013, accepted (with revisions): October 1, 2013 ª 2014 Elsevier Inc. 0090-4295/14/$36.00 411 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2013.10.003