Older adults experience more prevalent and severe lower urinary tract symptoms (LUTS) and have a higher risk of ineffective LUTS treatments. Both older age and LUTS are independent risk factors for poor physical function; however, prior studies focused on single gender and often focused on specific LUTS subtypes. We hypothesized that LUTS, comprehensively assessed via multiple questionnaires, would be associated with worse self-reported physical function among care-seeking women and men.

We performed a secondary cross-sectional analysis of the LURN I (Symptoms of Lower Urinary Tract Dysfunction Research Network) Observational Cohort Study. This multi-center cohort included men and women who reported any LUTS at a frequency more than rarely during the last month and were seeking care at a tertiary care center. At baseline the study participants underwent a standardized clinical evaluation and completed two validated LUTS questionnaires: (1) Urinary Distress Inventory short-form 6 (UDI-6, women only) and (2) the American Urological Association Symptom Index (AUASI) in men and women, as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility subdomain v1.2 to assess physical function (PROMIS-PF). PROMIS-PF is scored on the t scale with higher t-scores reflecting better physical function, with ≥55 indicating normal function. Demographic and clinical data were collected at baseline and reported by PROMIS-PF score tertiles. We used multivariable Tobit regression models to estimate the mean difference in PROMIS-PF score per 1 standard deviation in each LUTS measure. Models were stratified by sex and adjusted for age, demographics, body mass index (BMI), waist circumference, health-related behaviors, and comorbidities.

A total of 514 women and 500 men were enrolled in the study. On average, age, BMI, waist circumference, depression, anxiety, and sleep disturbance were greater among those with lower (worse) PROMIS-PF scores in both women and men (Table 1).  In women, greater LUTS severity, urinary bother, and distress were associated with lower self-reported physical function in both age-adjusted and fully adjusted models (Table 2). For example, each 7-point increment in AUASI was associated with a 1.95 lower PROMIS-PF t-score (95%CI -2.89, -1.02), and this association was stronger for the storage sub score compared to the voiding sub score. Similarly, in women, each 24-point increment in UDI-6 was associated with a 1.72 lower PROMIS-PF t-score (95%CI -2.63, -0.81) after adjusting for confounders. In men, greater LUTS severity and urinary bother were associated with lower PROMIS-PF t-scores in age-adjusted models, but these associations did not remain statistically significant after multivariable adjustment.

In women seeking care for LUTS at a tertiary care center, greater LUTS severity was strongly and independently associated with worse physical functioning. In contrast, among men, these associations were attenuated and no longer statistically significant after adjustment for demographic and clinical characteristics.

Older adults with concomitant LUTS and physical function impairments likely have increased perioperative complications and worse outcomes after LUTS treatments. Physical function impairment is intimately related to lower urinary tract dysfunction in women, regardless of how LUTS are measured. Previously observed associations in community-dwelling men were not replicated in this care-seeking study population. Therefore, pre-treatment screening for physical function impairments may improve perioperative care and success of LUTS treatments. Future studies are needed to understand the impact of impaired physical function on LUTS outcomes after treatment.