© 2 0 0 5 B J U I N T E R N A T I O N A L | 9 6 , 8 3 – 8 7 | doi:10.1111/j.1464-410X.2005.05572.x 83 Original Article SEVERITY OF INCONTINENCE, VOIDING FREQUENCY AND QoL IN MEN WITH LUTS HALTBAKK et al. Relevance and variability of the severity of incontinence, and increased daytime and night-time voiding frequency, associated with quality of life in men with lower urinary tract symptoms JOHANNES HALTBAKK, BERIT R. HANESTAD and STEINAR HUNSKAAR Department of Public Health and Primary Health Care, University of Bergen, Norway Accepted for publication 31 January 2005 BPH were collected by questionnaire shortly after referral from their general practitioner in 1997–2000. The International Continence Society – Benign Prostatic Hyperplasia Index, Sandvik’s Incontinence Severity Index, and the World Health Organization Quality of Life Survey – Abbreviated Version (WHOQoL-bref) were used to assess symptoms and QoL. RESULTS There was a large heterogeneity of self- reported symptom severity and related bother in the three symptoms of UI, increased daytime voiding frequency and night-time voiding in these referred patients. The WHOQoL-bref showed significant group differences of subjectively relevant symptoms. CONCLUSION The perception of increased night and daytime frequency, as measured by symptom severity and bother, varied greatly. The severity of UI and its effect on men waiting for a urological assessment of LUTS suggestive of BPH also varied widely. In general, the symptoms and their impact were slight to moderate. The WHOQoL-bref could be used to differentiate among groups of subjectively relevant symptoms, and in so doing supported information generated by the bother question. KEYWORDS LUTS, BPH, quality of life, storage, urinary incontinence, subjective relevance, bother OBJECTIVES To estimate the distribution of the severity of urinary incontinence (UI) and daytime and night-time voiding in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH); to estimate the proportion of ‘subjectively relevant’ symptoms within each severity category; to identify differences in quality of life (QoL) by degree of subjectively relevant daytime and night-time symptoms; and to identify differences in QoL in men with subjectively relevant UI or no UI. PATIENTS AND METHODS Data from a group of 480 men awaiting urological assessment for LUTS suggestive of INTRODUCTION Urinary incontinence (UI) and increased daytime and night-time voiding frequency are often regarded as the most bothersome LUTS [1–5]. Bother reflects men’s overall distress with having LUTS [6]. Subjectively relevant symptoms must be distinguished from healthy functioning. For UI and increased daytime and night-time voiding frequency, this differentiation may be achieved by estimating the bother associated with leakage and the number of voids during day or night. Generally, it seems that LUTS suggestive of BPH do not greatly impair quality of life (QoL) [7,8]; there are few reports on the association between the subjective relevance of storage symptoms and QoL, e.g. to date, the QoL questionnaire developed by the WHO (brief version, WHOQoL) has not been used to investigate differences in QoL in patients bothered by LUTS suggestive of BPH. However, two studies investigated the association between the ‘bothersomeness’ of LUTS and well-being/health status, concepts closely related to QoL; the correlations were high in these studies [9,10]. The purpose of the present study was to estimate the distribution of the severity of UI, and daytime and night-time voiding in patients with LUTS suggestive of BPH, and to estimate the proportion of subjectively relevant symptoms within each severity category. Further, we identified differences in QoL by the degree of subjectively relevant daytime and night-time symptoms, and differences in QoL in men with subjectively relevant UI and men with no UI. PATIENTS AND METHODS Men waiting for a urological evaluation at Trondheim University Hospital, Norway, in 1997–2000 were eligible for the study. Based on an overall assessment of his GP’s description of the patient in the referral letter, the urologist made the tentative diagnosis of BPH for 612 referred patients, who were subsequently enrolled in the study. The eligible patients were sent information about the waiting list situation, a request to participate in the study and a questionnaire. Patients agreed to participate by returning the questionnaire and a signed consent form in a pre-stamped envelope; one reminder was sent. Ethics approval was obtained from the regional ethics review board. The ICS has defined UI as the complaint of any involuntary leakage of urine [1]. Increased daytime frequency is defined as the complaint by the patient that he/she voids too often by day [1]; night-time frequency is defined as voids that occur from the time the individual goes to bed with the intention to sleep, to the time the individual wakes with the intention of rising [1,11,12].