Jukka Häkkinen

Effect of life-style factors on incidence of erectile dysfunction.

We estimated the incidence of erectile dysfunction (ED) in a population-based sample during 5-y follow-up and determined how the rate was affected by sociodemographic and life-style factors. The target population comprised all men aged 50, 60 or 70 y residing in the city of Tampere or 11 surrounding municipalities in Finland at the start of follow-up. A questionnaire was mailed to 3143 men in 1994 and to 2864 in 1999. The follow-up sample consisted of 1442 men who responded to both baseline and follow-up questionnaires. We estimated the effect of sociodemographic and life-style factors on the incidence of ED among the 1130 men free of ED at baseline. We found no differences in the incidence of ED by the level of education, marital status, urban/rural place of residence, amount of alcohol and coffee consumption. Obesity (rate ratio (RR)=1.7, 95% confidence interval (CI): 1.1–2.5) and current smoking (RR=1.5, 95% CI: 0.9–2.2) increased the incidence of ED. Current smokers free of comorbidity were also at higher risk of ED (RR=1.3, 95% CI: 0.8–2.1), but no effect was observed among past smokers. Our results indicate that sociodemographic and life-style factors, except age and obesity, have little influence on ED.

Depressive Symptoms Increase the Incidence of Nocturia: Tampere Aging Male Urologic Study (TAMUS)

PURPOSE We assessed the effects of depressive symptoms on the incidence of nocturia in men. MATERIALS AND METHODS The target population comprised all men who were 50, 60 or 70 years old and residing in the Tampere area in 1994. A self-administered questionnaire was mailed to 3,143 randomly selected men in 1994 and a second round was mailed to the 2,837 who were alive and eligible in 1999. The followup sample consisted of 1,580 men with information on nocturia available at baseline and followup. RESULTS The incidence of mild to severe nocturia was 75 cases per 1,000 person-years (95% CI 66-85) and that of moderate or severe nocturia was 9 (95% CI 7-11). Men with depressive symptoms at study entry were at 2.8 times higher risk (95% CI 1.5-5.2) for moderate or severe nocturia than those without depressive symptoms. A dose response relation was found between the severity of depressive symptoms at baseline and the incidence of moderate or severe nocturia. Each unit increment in the short form of the Mental Health Inventory score on a scale of 5 to 30 increased the incidence rate ratio of moderate or severe nocturia by 10% (95% CI 4-16). Only untreated depressive symptoms increased the incidence of moderate or severe nocturia (adjusted RR 3.3, 95% CI 1.7-6.2) but not medically treated symptoms. Nocturia at study entry had no significant effect on depressive symptoms during followup. CONCLUSIONS Our findings show a unidirectional effect of depressive symptoms on the incidence of moderate or severe nocturia. Untreated depressive symptoms may cause nocturia.

Cardiovascular drug use and the incidence of erectile dysfunction

It is unclear whether high blood pressure per se or antihypertensive drug use causes erectile dysfunction (ED). The aim of this study was to investigate the effect of cardiovascular diseases and their concomitant medications use on the incidence of ED. The target population consisted of men aged 55, 65 or 75 years old residing in the study area in Finland in 1999. Questionnaires were mailed to 2837 men in 1999 and to 2510 of them 5 years later. The follow-up sample consisted of 1665 men (66% of those eligible) who responded to both baseline and follow-up questionnaires. Men free of moderate or severe ED at baseline (N=1000) were included in the study. ED was assessed by two questions on subject ability to achieve or maintain an erection sufficient for intercourse. Poisson regression model was used in the multivariable analyses. The risk of ED was higher in men suffering from treated hypertension or heart disease than in those with the untreated condition. The risk of ED was higher in men using calcium channel inhibitor (adjusted relative risk (RR)=1.6, 95% confidence interval (CI) 1.0–2.4), angiotensin II antagonist (RR=2.2, 95% CI 1.0–4.7), non-selective β-blocker (RR=1.7, 95% CI 0.9–3.2) or diuretic (RR=1.3, CI 0.7–2.4) compared with non-users. ED was not associated with using organic nitrates, angiotensin-converting enzyme inhibitors, selective β-blockers and serum lipid-lowering agents. In summary, calcium channel inhibitors, angiotensin II antagonists, non-selective β-blockers and diuretics may increase the risk of ED.

Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Incidence of Erectile Dysfunction

PURPOSE We estimated the effect of nonsteroidal anti-inflammatory drug use on the incidence of erectile dysfunction. MATERIALS AND METHODS The target population consisted of men 50, 60 or 70 years old residing in the study area in Finland in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. The followup sample consisted of 1,683 men who responded to baseline and followup questionnaires. We estimated the effect of NSAIDs on the incidence of ED in men free from moderate or complete ED at baseline (in 1,126). ED was assessed by 2 questions on subject ability to achieve or maintain an erection sufficient for intercourse. Confounding was assessed by stratification and by adjustment in multivariate Poisson regression model. RESULTS The incidence of ED was 93 cases per 1,000 person-years in men who used and 35 in those who did not use NSAIDs. Among men with arthritis, the most common indication for NSAID use, ED incidence was 97 cases per 1,000 in those using and 52 in men who did not use NSAIDs. Compared with men who did not use NSAIDs and were free from arthritis, the relative risk of ED after controlling for the effects of age, smoking, and other medical conditions and medications was higher in men who used NSAIDs but were free of arthritis (IDR 2.0, 95% CI 1.2-3.5) and in those who used NSAIDs and had arthritis (IDR 1.9, 95% CI 1.2-3.1). The relative risk was only somewhat higher in men who had arthritis but did not use NSAIDs (IDR 1.3, 95% CI 0.9-1.8). CONCLUSIONS The use of nonsteroidal anti-inflammatory drugs increases the risk of ED and the effect is independent of indication.

The Effects of Lifestyle Factors on the Incidence of Nocturia

PURPOSE Cross-sectional studies have shown an association between obesity and nocturia but controversial findings on the relationship between smoking, alcohol and coffee consumption, and nocturia. Prospective studies of the role of lifestyle factors in individuals with nocturia are scarce. We investigated the effects of lifestyle factors on the incidence of nocturia. MATERIALS AND METHODS The target population consisted of men who were 50, 60 or 70 years old and residing in Tampere in 1994. A questionnaire was mailed to 3,143 randomly selected men in 1994 and the survey was repeated in 1999 with the 2,837 who were still eligible. The followup sample consisted of 1,580 men with information on nocturia at baseline and 5-year followup. Nocturia was assessed by the Danish Prostate Symptoms Score 1 questionnaire and graded as mild--1 or 2, moderate--3 or 4 and severe--5 or more nightly voids. RESULTS Higher body mass index at baseline was associated with an increased incidence of nocturia. Obese men were at 1.6 times (95% CI 1.1-2.4) higher risk for mild nocturia and at 2.3 times (95% CI 1.1-4.7) higher risk for moderate or severe nocturia compared with men who had a normal body mass index. Men who consumed less than 150 gm alcohol per week were at lower risk for moderate or severe nocturia than abstainers (adjusted incidence rate ratio 0.4, 95% CI 0.2-0.8). No statistically significant associations were found for smoking and coffee consumption. The frequency of nocturia at baseline did not increase the incidence of obesity at followup. CONCLUSIONS Our findings suggest that obesity increases the risk of nocturia. The link between other lifestyle factors and nocturia is weak or absent.

Erectile dysfunction influences the subsequent incidence of lower urinary tract symptoms and bother

It is unclear whether lower urinary tract symptoms (LUTS) cause erectile dysfunction (ED) independently or through common underlying pathophysiology and shared risk factors. The aim of this study was to investigate the effect of ED on the incidence of frequency and bother of LUTS. Target population consisted of men aged 50, 60 or 70 years residing in the study area in Finland in 1994. Questionnaires were mailed to 3143 men in 1994 and to 2837 of them 5 years later. The follow-up sample comprised 1683 men who responded to both baseline and follow-up surveys. ED was assessed by two questions on subjects ability to achieve or maintain an erection sufficient for intercourse and LUTS by the Danish Prostatic Symptom Score questionnaire. A dose–response relation was found between the severity of ED at baseline and the incidence of LUTS or bother during follow-up. After adjustment for the confounders, the incidence rate ratio (RR) of LUTS was higher in men with moderate (RR 1.5, 95% confidence interval (CI) 1.0–2.3) or severe ED (RR 2.3, 95% CI 1.4–3.8) than in those free of ED at entry. Compared with men free of ED at baseline, the RRs of urinary bother were 1.6 (95% CI 1.1–2.4), 1.9 (95% CI 1.1–3.2) and 2.2 (95% CI 1.1–4.3) for minimal, moderate or severe ED, respectively. In summary, ED is associated with an increased incidence of LUTS and bother. ED and LUTS may have a common underlying pathophysiology or shared risk factors.

Relationship between smoking and erectile dysfunction

We estimated the effects of smoking on the risk and prognosis of erectile dysfunction (ED), and of ED on smoking behavior. The follow-up sample consisted of the 1442 men aged 50–75 y, who responded to both baseline and follow-up questionnaires. We estimated the effect of smoking on the incidence of ED among the 1130 men free from ED, ED on risk to start smoking in the 502 nonsmokers, smoking on the prognosis of ED among the 312 with ED and ED on quitting smoking among the 292 current smokers at baseline. Risk of ED increased nonsignificantly with smoking (odds ratio (OR)=1.4), while ED recovery reduced (OR=0.6). Therefore, there was the ratio of 2.3 (1.4/0.6) describing the total effect of smoking on the risk of ED. Both quitting (OR=1.7) and starting (OR=1.9) smoking were rare and nonsignificantly higher in men with ED. Most of the OR estimates on smoking–ED relationships were not statistically significant, probably due to small numbers. There are two bidirectional relations between ED and smoking. Those who smoked had a higher risk of ED than nonsmokers. The men with ED were more likely to start smoking than those free from ED. The estimates of effects were not statistically significant, but they were consistent with each other and with the hypothesis that smoking causes ED and ED causes smoking. The recovery from ED was less in smokers than among nonsmokers, and current smokers with ED were more likely to stop smoking than men free from ED. Numbers were few and estimates of effects were not significant, but consistent with the hypothesis of smoking preventing recovery from ED and ED improving the success of smoking cessation. Such transitions in four directions explain indirectly the known positive association between the prevalence of smoking and the prevalence of ED.

Changes in prevalence of urinary symptoms in Finnish men--a population-based 5-year follow-up study.

Objective: To describe changes in the prevalence and severity of urinary symptoms and the degree of interference they cause in the daily life of the Finnish male population by means of a 5-year follow-up study. Material and Methods: A postal survey of a stratified random population sample of elderly men in Pirkanmaa County was carried out in 1994 and 1999. A total of 3143 men in 1994 and 2837 in 1999 received the questionnaire; 2198 (70%) and 2133 (75%) responded, respectively. The questionnaire included items on sociodemographic status, overall health and diseases, urinary symptoms (Danish Prostatic Symptom Score), sexual function and bothersomeness of symptoms. Data from those individuals who responded adequately to both inquiries were analysed. Results: The most prevalent urinary symptoms were post-micturition dribble (64%), nocturia (62%), hesitancy (50%) and incomplete emptying (46%). At the 5-year follow-up, the prevalences of hesitancy, incomplete emptying, nocturia, urge incontinence and stress incontinence had increased statistically significantly. Subjects who had been symptomatic at baseline reported no change in 46-77% of cases, deterioration in 2-19% and improvement in 16-52%. The degree of interference in daily activities due to urinary symptoms increased significantly during follow-up. The mean interference index increased from 2.3 to 4.4. Conclusion: Although urinary symptoms in elderly males are particularly common and their prevalence increases with age, they are mostly mild and also have a marked tendency to improve with time. The total burden of urinary symptoms nonetheless increases with age in the elderly male population.

Empirical evaluation of grouping of lower urinary tract symptoms: principal component analysis of Tampere Ageing Male Urological Study data.

The ICS has divided LUTS into three groups: storage, voiding and post‐micturition symptoms. The classification is based on anatomical, physiological and urodynamic considerations of a theoretical nature. We used principal component analysis (PCA) to determine the inter‐correlations of various LUTS, which is a novel approach to research and can strengthen existing knowledge of the phenomenology of LUTS. After we had completed our analyses, another study was published that used a similar approach and results were very similar to those of the present study. We evaluated the constellation of LUTS using PCA of the data from a population‐based study that included >4000 men. In our analysis, three components emerged from the 12 LUTS: voiding, storage and incontinence components. Our results indicated that incontinence may be separate from the other storage symptoms and post‐micturition symptoms should perhaps be regarded as voiding symptoms.

Prevalence of hesitancy in 30-80-year-old Finnish men: Tampere Ageing Male Urological Study (TAMUS).

Study Type – Therapy (symptom prevalence)