Vol.:(0123456789) 1 3 World J Urol DOI 10.1007/s00345-016-1999-8 ORIGINAL ARTICLE Is there room for behavioral and modifable health-related targets in the lower urinary tract symptoms’ scenario Osamu Ikari 2  · Brunno C. F. Sanches 2  · João Carlos Cardoso Alonso 3  · Fabiano A. Simões 3  · Ronald F. Rejowski 3  · Walker Wendel Laranja 3  · Leonardo O. Reis 1,2,3   Received: 22 October 2016 / Accepted: 30 December 2016 © Springer-Verlag Berlin Heidelberg 2017 increasing the weekly sexual frequency (OR = 0.80, 95% CI = 0.69–0.91, p = .0012) and increasing HDL cholesterol (OR = 0.98, 95% CI = 0.97–0.99, p = .037). Odds were not signifcant for age of sexual initiation, precocious ejacu- lation, masturbatory pattern, physical activity, smoking, alcohol consumption, penile length (objective and subjec- tive), abdominal circumference, obesity, comorbid condi- tions, metabolic syndrome, serum glycaemia, testosterone, SHBG, PSA, and estradiol. Conclusions One in every four men under routine urolog- ical evaluation who considered themselves healthy present moderate and severe LUTS. Modifable behavioral (educa- tion, sexual frequency, and ejaculation) and health-related (blood pressure and HDL cholesterol) targets were identi- fed for future interventional studies and potential preven- tive actions and patient counseling. Keywords Voiding · Chronic pelvic ischemia syndrome · Risk factor · IPSS Introduction The etiology of lower urinary tract symptoms (LUTS) is multifactorial, and a major risk factor is advancing age. Due to increasing longevity, the population aging continues to rise around the world, associated with a critical negative impact on quality of life and a heavy economic burden. By 2018, the number of individuals afected by at least one LUTS is expected to increase by 18% to 2.3 billion, with an estimated 1.1 billion persons afected by bladder outlet obstruction, mainly prostate related [1]. In addition to age-related void dysfunction, many stud- ies have proposed hypothetical etiopathological roles for behavioral and health-related features, and while chronic Abstract Purpose To better understand potential modifable risk factors guiding preventive interventions against lower uri- nary tract symptoms (LUTS). Methods A prospective cross-sectional study, including healthy men aged 40–70 years under routine urological evaluation, measured the strength of association between the International Prostate Symptom Score (IPSS) and socio-demographic, lifestyle, and health-related factors using logistic and linear regression adjusted for confound- ing factors. Men with urethral or prostate surgery were excluded. Results Among 743 men, mean age 59.64 ± 9.66, 22.6% reported moderate, and 5.0% severe LUTS. The adjusted odds of severe LUTS increased with: increasing age (OR = 1.07, 95% CI = 1.05–1.09, p < .0001), increas- ing prostate volume (OR = 1.02, 95% CI = 1.01–1.04, p = .004), decreasing education (tertiary qualifcation, no versus yes, OR = 2.34; 95% CI = 1.16–4.70; p = .0133), delayed ejaculation (yes versus no, OR = 2.63, 95% CI = 1.43–4.83, p < .0001), and increasing blood pres- sure (systolic ≥130 mmHg, OR = 2.03, 95% CI = 1.44– 2.86, p < .0001 or diastolic ≥85 mmHg, OR = 1.47, 95% CI = 1.03–2.10, p = .0345); severe LUTS decreased with: O. Ikari and B. C. F. Sanches equally contributed to this work. * Leonardo O. Reis reisleo.l@gmail.com 1 Urologic Oncology, Faculty of Medicine, Center for Life Sciences, Pontifcal Catholic University of Campinas (PUC- Campinas), Campinas, São Paulo, Brazil 2 University of Campinas, Unicamp, São Paulo, Brazil 3 Paulínia Municipal Hospital, São Paulo, Brazil