Background/Purpose: Along the aging process, men frequently appeal lower urinary tract symptoms (LUTS). The impact of LUTS on quality of life and mental health was apparent regardless of the East and West.  Recently, uric acid (UA) has emerged as a modulator of prostate cells. Because UA acts like two-faced Janus, antioxidants or pro-oxidants, depending on its chemical microenvironment, hyperuricemia has been proposed to link to various diseases independent of crystal formation. Although UA has been shown to play a role in prostate pathology, there has been scarce investigation between UA and LUTS, irrespective of prostatic hyperplasia and prostate cancer. Therefore, we performed this study to assess the relationship serum uric acid (SUA) levels and the incidence of LUTS using a large sample of Korean middle-aged men who underwent comprehensive health screening exams.

Methods: A cohort study was performed in 101,091 Korean men, free of LUTS at baseline, who underwent health check‐ups from 2011 to 2016. LUTS were assessed using the International Prostate Symptom Score (IPSS) and clinically significant LUTS were defined as an IPSS score ≥8. Men are divided into 6 groups according to SUA level in mg/dl (< 5.5, 5.5–6.4, 6.5–7.4, 7.5–8.4, 8.5–9.4, and ≥9.5). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident LUTS were estimated using Cox proportional hazards regression analysis. Stratified analyses were also conducted in pre-specified subgroups: age (< 50 vs. ≥50 years), smoking (none vs. ever smoker), alcohol consumption (< 20 g/day vs. ≥20 g/day), physical activity (health enhancing physical activity; no vs. yes) and body mass index (BMI) (< 25 kg/m² vs. ≥25 kg/m²).

Results: During a total of 358,982.6 person-years of follow-up, 13,424 people developed significant LUTS (incidence rate, 37.3 per 1,000 person-years). In a multivariable model adjusted for age, center, year of screening examination, education level, BMI, alcohol intake, regular exercise, hypertension, diabetes mellitus, and estimated glomerular filtration rate, the highest level of SUA (< 9.5mg/dl) was associated with decreased risk of significant LUTS. The multivariable‐adjusted HR for significant LUTS in the highest SUA categories compared with the reference category (< 5.5mg/dl) was 0.77 (95% CI 0.59-0.99). The association of the SUA levels with the risk of significant LUTS was examined by pre-specified subgroups, and the trend of decreasing risk for significant LUTS along the increasing SUA levels was predominant in age < 50 years.

Conclusion: In this large cohort of middle-aged men, higher SUA level was predictive of decreased risk of LUTS. This suggests another important role of SUA for preventing LUTS. A further study is warranted to elucidate the biological mechanisms underlying this association.

2019 ACR table_SUA-LUTS

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-of-serum-uric-acid-levels-and-the-risk-of-lower-urinary-tract-symptoms-in-korean-healthy-adults/