Table 1: Demographic and clinical variables of the patients (N=165).

Table 2: Symptoms of LUTS in the patients (N=165).

LUTS: Lower Urinary Tract Symptoms; IPSS: International Prostate Symptom Score

Table 4: Multivariable binary logistic regression analysis of data about LUTS.

Table 5: Stratification of data about Quality of Life (N=165).

Table 6: Multivariable binary logistic regression analysis of data about poor QOL.

CI: Confidence Interval, QOL: Quality of Life, S.E: Standard error, *Significant at p<0.05

DISCUSSION

The findings of our study reveal a high prevalence of LUTS among adult males presenting to the urology clinic, with nearly three-quarters (73.9%) of participants reporting at least one symptom and one-third (33.9%) experiencing severe LUTS. This aligns with previous reports from the region and globally, which indicate prevalence estimates as high as 85% in India and 89.8% in Malaysia [8, 13]. Globally, the incidence of LUTS varies significantly, ranging from 13% to 70% [14-16]. Several studies conducted in Pakistan regarding the incidence of LUTS in the past have reported low incidences: 33.7% in the population studied by Salman et al. and 23.5% by Shahzad et al. [6, 7]. These changes may be attributed to age variability, diagnostic criteria used, symptom perception, and differences in the population, as suggested in this study. For example, the patient population attending urology clinics may show a higher incidence than the general population in the country. The symptoms in the present study's patient population include urinary frequency, urgency, and nocturia, accounting for 67.8%, 63.0%, and 54.5% of cases, respectively. Similar surveys have highlighted nocturia and weak urinary streams as common presentations, with erectile dysfunction often being associated [8, 10]. Even though the role of frequency of erectile dysfunction was not evaluated, the prevalence of erectile dysfunction that was documented justifies the need to consider it as another factor that may shape behavior. Future research should explore erectile dysfunction, recognizing its role, even as the patient presents with lower urinary tract symptoms [17, 18].

Even though univariate analysis for our research showed various associations with LUTS, including advancing age, diabetes mellitus, and hypertension, multivariate analysis did not reveal similar associations. No patient factors showed statistical significance. However, the literature shows involvement of various metabolic factors, as well as advancing age, in LUTS [19, 20]. For instance, different research papers have shown the considerable association of diabetes and hypertension with LUTS, particularly in the neighboring Indian population [8, 20]. Kant et al. also reported a borderline statistical association between tea intake >2 per day and LUTS, possibly due to the beverage's diuretic effects [5]. In our study, 77% of participants consumed more than two cups of tea per day. While tea intake was associated with poor QOL on univariate analysis, this association did not persist in multivariable analysis. Similarly, other lifestyle factors, such as alcohol use, showed variable associations with QOL but not with LUTS prevalence, suggesting a more complex interplay of behavioral and physiological characteristics. Although alcohol use was associated with lower odds of poor QOL in our study, this finding does not imply causality. It should be interpreted cautiously due to the small number of alcohol users and the wide confidence interval, and it should not be taken to indicate a protective effect of alcohol. Overall, the negative impact of LUTS on QOL observed in our study suggests the importance of routine screening, particularly among older adults and individuals with comorbidities or high-risk lifestyle habits. It has also been reported in previous studies that increasing comorbid conditions and poor QOL influence seeking medical help in older men with LUTS [13, 21, 22]. These findings reinforce the value of integrating validated symptom assessment tools, such as the IPSS, into primary and outpatient care to facilitate timely diagnosis and appropriate management.

This study has several limitations, including the issue of complete separation and its impact on regression modelling, the limited generalisability due to the single-centre, urology OPD-based, non-probability sample, and the use of a single IPSS QOL item rather than a multi-domain QOL instrument. The cross-sectional clinic-based study design prevents the establishment of causal relationships between risk factors and LUTS or QOL. Because the study was conducted at a single institution using nonprobability consecutive sampling, the findings may not be generalizable to the broader male population. Additionally, we did not investigate the underlying causes of LUTS, and self-reported data on urinary symptoms and lifestyle factors may be subject to recall or reporting bias. Potential confounding variables may also have influenced the observed associations. Despite these limitations, this study used the IPSS questionnaire, a reliable and validated tool, to provide valuable information on LUTS and QOL in adult males in Lahore, Pakistan. In relation to this, the implications of this study for clinicians are evident, particularly in understanding LUTS and its influence on QOL, emphasizing the necessity of screening, especially in older adults and those with comorbid conditions. Future research should focus on large-scale, multicenter, and longitudinal studies to explore causal relationships and the effects of lifestyle and metabolic factors. Integrating validated tools such as the IPSS into primary and outpatient care facilitates early diagnosis, guides management, and improves patient quality of life.

CONCLUSION

The present study reported a high prevalence of LUTS, with approximately one-third of the patients reporting severe LUTS symptoms. Moreover, urinary frequency and urgency were the most frequently reported symptoms of LUTS, and LUTS symptoms also had a notable effect on quality of life among patients. Thus, identifying these patients, especially senior citizens and those with comorbid conditions, may significantly benefit from symptom management. Furthermore, diagnostic tools such as IPSS may also be appropriately employed in routine clinical practice to improve patient care through early diagnosis and management.

ETHICS APPROVAL

This study was conducted after obtaining ethical approval from the Institutional Ethical Review Committee of Azra Naheed Medical College, Superior University, Lahore (IRB#ANMC/IRB/2025/024), Pakistan, dated April 30, 2025, before data collection. All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and the Helsinki Declaration.

CONSENT FOR PUBLICATION

Written informed consent was obtained from each patient before inclusion in the study.

AVAILABILITY OF DATA

Data generated or analyzed during this study are available from the corresponding author upon reasonable request.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ACKNOWLEDGEMENTS

Declared none.

AUTHORS' CONTRIBUTION

This study was conceived and designed by BW, NIB, and AB. BW, NIB, UJ, and AB did the initial literature research. BW and NIB conducted data collection, patient assembly, and assessment. NIB, BW, and UJ did data analysis and interpretation. BW, UJ, and NIB were involved in manuscript writing. NIB, AB, and BW did the final critical review and corrections. All authors read and approved the final manuscript.

GENERATIVE AI AND AI-ASSISTED TECHNOLOGIES IN THE WRITING PROCESS

In this study, author made limited use of ChatGPT (GPT-4, OpenAI) for minor proofreading and language suggestions. Author reviewed and edited the content as needed and takes full responsibility for the manuscript content.

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