Accessing and evaluating urologic health information: differences by race/ethnicity and gender.

Patients with urologic symptoms seek information from a variety of sources outside the traditional health care arena. There are differences between the genders and racial/ethnic groups related to sources consulted and confidence in those sources.

Comparison of health-related quality-of-life outcomes for African-American and Caucasian-American men after radical prostatectomy.

UNLABELLED: What's known on the subject? and What does the study add? In addition to a higher prevalence and biological aggressiveness of prostate cancer, African-Americans tend towards narrower pelvises than Caucasians resulting in a potentially more difficult surgical dissection doing radical prostatectomy and increased positive surgical margins. In this study, there was no difference in urinary or sexual HRQL or overall satisfaction between African-Americans and Caucasians 2 years after radical prostatectomy, suggesting that the potential technical challenges of a narrower pelvis do not translate into poorer outcomes for African-Americans. OBJECTIVE: To determine if any differences exist in postoperative health-related quality-of-life (HRQL) outcomes, e.g. erectile function and continence, after radical prostatectomy (RP) in African-American (AA) vs Caucasian-American (CA) men. PATIENTS AND METHODS: Between October 2000 and July 2008, 1338 CA and 56 AA men underwent open RP by a single surgeon and signed informed consent to participate in a prospective longitudinal outcomes study. The American Urological Association Symptom Score (AUA-SS) and University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and a global assessment of satisfaction were self-administered at baseline and after RP 24 months. Urinary, sexual, and satisfaction outcomes were compared at 24 months. RESULTS: AA men had significantly higher rates of hypertension and diabetes. There were no other significant baseline differences in age, co-morbidities, body mass index, phosphodiesterase type 5 inhibitor use, preoperative prostate-specific antigen level, AUA-SS, and UCLA-PCI scores. There were no differences in the percentage of men undergoing nerve-sparing procedures, estimated blood loss, transfusion rates, or complication rates between the groups. At 24 months after RP the mean UCLA-PCI urinary and sexual function and bother scores and global satisfaction scores were similar between the groups. CONCLUSION: AA and CA men experience no significant differences in urinary and sexual HRQL or overall satisfaction after open RP when performed by a single experienced surgeon.

Complementary and alternative therapies for urinary symptoms: use in a diverse population sample qualitative study.

Study participants reported a range of remedies used to treat urinary symptoms, from popular products, such as saw palmetto, to less commonly known remedies, such as moabi. Participants learned about remedies through social network rather than from their primary care provider.

Doing the best to control: the experiences of Taiwanese women with lower urinary tract symptoms.

BACKGROUND: In Taiwan, most women with lower urinary tract symptoms live quietly with their symptoms without seeking medical help. These women's voices have not been heard or investigated. OBJECTIVES: The purpose of this study was to generate descriptive theory on the basis of the lived experiences of Taiwanese women with lower urinary tract symptoms. METHODS: A qualitative study on the basis of grounded theory was used. Sixteen Taiwanese women with lower urinary tract symptoms aged 41-75 years participated in in-depth interviews. The data were analyzed using the constant comparative method. RESULTS: "Doing the best to control" was the core category for describing the process of women who used their own unique ways of controlling urination problems. During the process, "Irritating urination problems" was the term identified as the antecedent condition. The woman would then begin the process of "doing the best to control," which would be marked by action and interaction among four categories: (a) self-limited activities, (b) modify daily life, (c) always looking for the toilet while outdoors, and (d) feeling stress and uneasiness. After this phase, some women would begin "seeking medical help," "trying to practice a helpful lifestyle," or both. However, a few women just "did nothing, just living with it." DISCUSSION: Women do their best to improve self-control of their urination problems. However, stress and uneasiness permeate the process and overshadow their lives.

Beyond incontinence: the stigma of other urinary symptoms.

AIM: This paper is a report of a study conducted to characterize the stigma of urinary frequency and urgency and differentiate it from the stigma of incontinence and to describe race/ethnic and gender differences in the experience of stigma among a diverse sample of individuals. BACKGROUND: Lower urinary tract symptoms, including frequency, urgency and incontinence, are susceptible to stigma, but previous stigma research has focused almost exclusively on incontinence. METHOD: The Boston Area Community Health Survey is a population-based, random sample epidemiological survey of urologic symptoms (N = 5503). Qualitative data for this study came from in-depth interviews conducted between 2007 and 2008 with a random subsample of 151 black, white and Hispanic men and women with urinary symptoms. FINDINGS: Respondents reported stigma associated with frequency and urgency - not just incontinence. The stigma of frequency/urgency is rooted in social interruption, loss of control of the body, and speculation as to the nature of a non-specific 'problem'. Overall, the stigma of urinary symptoms hinged upon whether or not the problem was 'perceptible'. Men felt stigmatized for making frequent trips to the bathroom and feared being seen as impotent. Women feared having an unclean body or compromised social identity. Hispanic people in particular voiced a desire to keep their urinary symptoms a secret. CONCLUSION: The stigma of urinary symptoms goes beyond incontinence to include behaviours associated with frequency and urgency. Healthcare practitioners should assess for stigma sequelae (e.g. anxiety, depression) in individuals with frequency and urgency, and stress treatment options to circumvent stigmatization.

Prevalence of lower urinary tract symptoms in indigenous and non-indigenous women in Eastern Taiwan.

BACKGROUND/PURPOSE: To investigate the prevalence of lower urinary tract symptoms (LUTS), their impact on quality of life, and their association with socioeconomic and lifestyle factors among indigenous and non-indigenous women in Eastern Taiwan. METHODS: A total of 376 indigenous women and 509 non-indigenous women aged over 18 years were interviewed concerning LUTS in the recent 6 months using International Prostate Symptom Score questionnaires. RESULTS: Indigenous women had a higher prevalence of one or more LUTS than non-indigenous women (44.9%vs. 31.2%). Indigenous women had a significantly higher prevalence of urgency (7.7%vs. 4.3%, p = 0.024), straining to void (6.1%vs. 3.3%, p = 0.036), and nocturia (37.2%vs. 24.8%, p < 0.001) than non-indigenous women. There was no significant difference in the prevalence of impaired quality of life between indigenous and non-indigenous women (33.8%vs. 31.2%). Lower educational level, alcohol consumption, betel quid chewing, and cigarette smoking, and not difference in race, had significant effect on a higher prevalence of bothersome LUTS in indigenous women than non-indigenous women. CONCLUSION: Indigenous women with lower educational level and specific lifestyle risk factors have a higher prevalence of LUTS than non-indigenous women in Taiwan.

Lower urinary tract symptoms in relation to lifestyle and medical conditions in Japanese workers.

OBJECTIVES: To examine the association of medical conditions and lifestyle with lower urinary tract symptoms (LUTS) in a population of Japanese male workers. METHODS: A questionnaire survey on LUTS was conducted at the time of a periodic health examination among workers of a group of engineering and shipbuilding companies in Southern Kanto, Japan. A total of 1278 (85%) men responded. LUTS were assessed by using a modified International Prostate Symptom Score questionnaire. Men having at least one point of the score were regarded as positive. Logistic regression analysis was used to examine the relation of the LUTS to age, smoking, drinking, body mass index, and medical treatment of diabetes mellitus, hypertension, and dyslipidemia. RESULTS: Age was a strong determinant of LUTS. Men undergoing medical treatment for diabetes mellitus were significantly more likely to have LUTS than men without treatment (multivariate-adjusted odds ratio, 1.8; 95% confidence interval, 1.0-3.2). Increased odds of LUTS were also observed in men undergoing medical treatment for hypertension or dyslipidemia. Smoking, drinking alcohol, and obesity were not related to LUTS. CONCLUSIONS: Our present findings, together with previous epidemiological and experimental evidence, suggest that LUTS might share common etiological factors with diabetes mellitus, hypertension, and dyslipidemia.

Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey.

BACKGROUND: Previous studies of lower urinary tract symptoms (LUTS) have focused on men, with few studies including minority populations. The Boston Area Community Health (BACH) Survey is designed to study the prevalence and impact of LUTS among both men and women in a racially, ethnically, and socioeconomically diverse population. METHODS: The BACH Survey used a stratified 2-stage cluster design to randomly sample 5506 adults aged 30 to 79 from the city of Boston, Mass (2301 men, 3205 women, 1770 blacks, 1877 Hispanics, and 1859 whites). Data were obtained using interviewer and self-administered questionnaires. The presence of LUTS was defined as an American Urological Association symptom index score of 8 or above. Quality of life was assessed using the Medical Outcomes Study 12-Item Short Form Survey (SF-12), and a measure of bother was based on the interference of urinary symptoms with various activities. Analyses were weighted to the Boston population using SUDAAN version 9.0 statistical software. RESULTS: The overall prevalence of LUTS was 18.7% and increased with age (10.5% at age 30-39 years to 25.5% at age 70-79 years) but did not differ by sex or race/ethnicity. Quality of life was significantly reduced among those with LUTS, as measured by the bother of symptoms and the SF-12 component scores. Prevalence of prescription medication use for urinary symptoms was low even among participants with LUTS, with more than 90% of participants reporting no medication use. CONCLUSIONS: In this population-based, racially and ethnically diverse random sample, LUTS were common among both men and women and increased substantially with age. Lower urinary tract symptoms had a negative impact on quality of life across age, sex, and race/ethnic groups.

Prevalence of urinary incontinence symptoms among black, white, and Hispanic women.

OBJECTIVE: To compare the prevalence of urinary incontinence symptoms among black, white, and Hispanic women. METHODS: Women attending our gynecologic clinic were asked to complete a survey. The survey asked: "Do you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you wear a pad or protective undergarment because you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you urinate more than once every hour during the day? Does the urge to urinate wake you from your sleep more than twice most nights? Do you lose urine less than 5 minutes after you feel the urge to urinate more than once per week? RESULTS: Seven hundred ninety-nine black, 932 white, and 639 Hispanic women completed the survey. More white women reported urinary incontinence than did black or Hispanic women (41% versus 31% versus 30%, P <.001) because of their higher prevalence of stress incontinence symptoms (39% versus 27% versus 24%, P <.001). The percentage of women who had urge incontinence symptoms was very similar between the three groups (19% versus 16% versus 16%, P =.214). More black and white women reported mixed incontinence than Hispanic women (14% versus 15% versus 9%, P <.001). More black women had frequency and nocturia than the other two groups (31% and 35% versus 19% and 19% versus 25% and 26%, P <.001). CONCLUSION: The prevalence of incontinence symptoms is significantly different among black, Hispanic, and white women.

Analysis of the prevalence of voiding symptoms in Maori, Pacific Island, and Caucasian New Zealand men.

OBJECTIVES: Data from a community-based sample of 515 men were used to assess the prevalence and presentation of voiding symptoms in Caucasian, Maori, and Pacific Island men in the city of Porirua, New Zealand. METHODS: A random sample, stratified by age groups of 10 years, was obtained for men 40 years and older. Two hundred men were entered into each 10-year age stratum. Frequency of symptoms and quality of life were measured using the International Prostate Symptom Score (IPSS) questionnaire. Bothersomeness of symptoms was assessed using questions from the American Urological Association symptom bother index. Data were analyzed according to age and ethnic group with differences between groups measured by analysis of variance. RESULTS: Symptom score was found to increase with increasing age of subjects, with men in the 40 to 49 years age group recording a mean score (+/- SE) of 2.9 +/- 0.3, increasing to a mean score of 4.8 +/- 0.4 for men aged 50 to 59 years, 7.4 +/- 0.9 for men aged 60 to 69 years, and 7.4 +/- 0.9 for men in the 70 year and older age group. Significant symptoms, represented by a symptom score of 8 or greater, were found in 12.9% of men aged 40 to 49 years, 22.3% of men aged 50 to 59 years, 33.7% of men aged 60 to 69 years, and 33.3% in the 70 year and older age group. No difference was demonstrated in the prevalence of symptoms between Caucasian, Maori, and Pacific Island men. CONCLUSIONS: Despite having a similar prevalence of voiding symptoms to Caucasian men, few Maori or Pacific Island men seek help for their urinary symptoms. The level of understanding of the underlying disease process is poor for men of all ethnic backgrounds and emphasizes the important need for greater public awareness and education with respect to prostate disease.

Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men.

OBJECTIVE: The aim of this study was to examine associations between diabetes and clinical markers of benign prostatic hyperplasia (BPH) in community-dwelling white and black men aged 40-79 years. RESEARCH DESIGN AND METHODS: Data from the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men's Health Study were combined for a total study sample of 2,484 men. Severity of lower urinary tract symptoms (LUTS), peak urinary flow rates, prostate volume, and serum prostate-specific antigen (PSA) levels were examined by self-reported physician-diagnosed diabetes. RESULTS: Overall, 170 men (6.8%) reported a history of diabetes. Increased irritative LUTS and specifically nocturia were positively associated with diabetes. These patterns were consistent across race and persisted after adjustment for age, BMI, and various indicators of socioeconomic status. Furthermore, the relationship between irritative LUTS and diabetes was greater in black men. No significant associations were observed between diabetes and prostate volume, PSA level, and peak urinary flow rate. CONCLUSIONS: Our multiethnic community-based study demonstrates positive associations between diabetes and irritative LUTS and nocturia. Moreover, the association between irritative LUTS and diabetes is increased in black men. There was no strong evidence for an association between diabetes and BPH across measures more specific to BPH (i.e., prostate volume, PSA, and peak urinary flow rate). Taken together, our findings suggest that the presence of diabetes may be less related to prostate growth and more related to the dynamic components of lower urinary tract function. Further evaluations of the association between diabetes and BPH and related racial variations are warranted.

Cross-cultural adaptation and validation of the Portuguese version of the Bowel Function in the Community instrument.

PURPOSE: We sought to translate the Bowel Function in the Community instrument into the Portuguese language and to culturally adapt it to Brazilian society. We also aimed to test the validity and reliability (content validity, and interrater and test-retest reliability) of this adapted version. INSTRUMENT: The original instrument comprised 70 items grouped into 6 principal areas: general bowel habits, fecal incontinence, lower urinary tract symptoms, anorectal diseases and surgical history, medical care utilization, and potential contributing medical disorders. METHODS: The instrument was translated into Portuguese, and assessed by a committee of specialists. Content validity of the translated version was verified by testing and via feedback from a focus group. The adapted version incorporated both semantic and idiomatic alterations. The instrument then underwent testing for interrater and test-retest reliability. RESULTS: Interrater reliability testing revealed a 94% level of agreement between interviewers and researchers. Test-retest reliability testing revealed a slightly higher than 60% level of agreement when the same subjects completed the instrument twice, during a baseline measurement and a second time following a 1-week interval. CONCLUSIONS: The adapted version of the Bowel Function in the Community instrument demonstrates adequate validity and reliability for use in research in the Brazilian population.

Measuring the urologic iceberg: design and implementation of the Boston Area Community Health (BACH) Survey.

OBJECTIVES: To describe the Boston Area Community Health (BACH) survey, a National Institutes of Health-supported epidemiological study of symptoms suggestive of the following urologic conditions: urinary incontinence, benign prostatic hyperplasia, interstitial cystitis, chronic pelvic pain of bladder origin, prostatitis, hypogonadism, erectile dysfunction, and female sexual dysfunction. METHODS: BACH used a two-stage stratified cluster design to recruit a community-based random sample of 5506, divided between males (2301) and females (3205), three racial/ethnic groups (black, Hispanic, and white), and four age groups (30-39, 40-49, 50-59, 60-79 yr). Validated questionnaires were used to collect information on urologic symptoms, comorbidities, prescribed and over-the-counter medications, reproductive history, quality of life, health care utilization, physical activity, depressive symptoms, interpersonal stress, smoking, alcohol use, fluid intake, nutrition, menopausal status, sexual activity, abuse, anthropometrics (measured height, weight, hip and waist circumference, pulse rate, blood pressure), and sociodemographics including country of origin, marital status, employment status, and income. Blood samples were collected from 68% of all subjects. RESULTS: A large representative community-based sample was successfully recruited to provide both cross-sectional and eventually longitudinal data to address important urologic questions. CONCLUSIONS: BACH has features distinguishing it from most other epidemiological studies in urology. It uses a random community-based sample of people who are racially/ethnically diverse and includes a broad age range (30-79 yr). It includes both males and females The study focuses on symptoms rather than variably defined disease conditions, it is multidisciplinary, and it is designed to become longitudinal.

Lower urinary tract symptoms and related help-seeking behaviour in South Asian men living in the UK.

OBJECTIVE: To describe the pattern and prevalence of lower urinary tract symptoms (LUTS) and related help-seeking behaviour in men of South Asian origin living in the UK, and to compare this to the white population. SUBJECTS AND METHODS: Data were obtained as part of the Leicestershire MRC Incontinence Study. Community-dwelling men aged >40 years were sent a postal questionnaire addressing urinary symptoms, bother and help-seeking. Prevalence rates of self-reported LUTS were compared on the basis of the Office of Population Censuses and Surveys ethnic classifications. Logistic regression was used to estimate the relative risk of symptoms between groups. Data from 7810 men were included in the analysis. RESULTS: In all, 409 (5.3%) of the population sample described themselves as Asian; 36.5% of these men described at least one significant LUTS, vs 29.0% of white men. The overall prevalence rates for all storage symptoms were significantly higher in Asian men. Straining to void was the only voiding symptom to show a difference in prevalence between the groups. However, when controlling for age, Asian men were at greater risk for all symptoms except a weak urinary stream. Reported levels of bother and felt need were the same in both population groups, but actual help-seeking was significantly less in the Asian group. Only 25.0% of Asian men had actively sought help, compared to 53.1% of white men. CONCLUSION: South Asian men in the UK have a higher risk of experiencing LUTS than white men from the same population. This increase in risk is greatest for storage symptoms. Although levels of bother are the same, South Asian men are less likely to seek help for their symptoms.

A population study of nocturia in Singapore.

OBJECTIVE: To estimate the prevalence of nocturia in the multiracial Asian population of Singapore, using the new International Continence Society standardized definition of one or more voids per night, and to assess its associations, bothersomeness and impact on sleep. SUBJECTS AND METHODS: A door-to-door interview questionnaire survey was conducted amongst a randomly selected sample of 3000 individuals (response rate 78.2%). Nocturia and its associated problems were evaluated using questions from the International Prostate Symptom Score (IPSS), and concurrently, sociodemographic and health variables were recorded. RESULTS: Data from 1134 women (aged 20-95 years) and 1139 men (aged 20-92 years) were analysed; the overall prevalence of nocturia (one or more voids/night) was 55.5%, with an increasing proportion in older groups (P < 0.01). Women had nocturia significantly (P = 0.015) more often than men (58% vs 53%), and it was positively associated with poor health, with the highest odds ratios (95% confidence interval) for diabetes mellitus of 2.0 (1.3-3.1), for renal disease of 6.4 (2.3-18.2), and for strokes of 3.1 (1.1-9.2). In both men and women, the median IPSS in patients with nocturia was significantly higher than that in patients without nocturia (P < 0.001). For individuals waking once a night, only 9.5% considered nocturia a problem and 13.5% complained of sleep disturbances; these values increased to 36% and 40% for individuals waking up twice or more /night. CONCLUSION: Nocturia is a common condition amongst Singaporean adults, especially in the elderly; it has strong associations with poor health and other lower urinary tract symptoms. The degree of nocturia determines whether patients are likely to be bothered by it or have sleep disturbance, which will influence their help-seeking behaviour.

Developing and validating a Chinese instrument to measure lower urinary tract symptoms among employed women in Taiwan.

Lower urinary tract symptoms (LUTS), including urinary incontinence, negatively affect women's quality of life. Employed women are particularly prone to experiencing the negative aspects of LUTS due to their irregular access to toilet facilities. In Taiwan, about 70% of women 25-44 years of age are employed, yet little research on LUTS in the workplace has been conducted. In this article, the development of a Chinese instrument for estimating prevalence of LUTS and identifying factors related to LUTS among employed women is discussed. After instrument-generation and translations, content validity of the instrument was assessed and found to be satisfactory. Following a pilot test, psychometric testing of the instrument (which included test-retest reliability and internal consistency) was conducted. Test-retest reliability for the majority of the items and internal consistency for the construct LUTS were adequate. Based on initial psychometric testing, the authors suggest the instrument is appropriate for use with women in Taiwan. Additional testing is recommended before being used with other populations.

Nocturnal polyuria in women with overactive bladder symptoms and nocturia.

OBJECTIVE: This study was undertaken to determine the prevalence of nocturnal polyuria in women complaining of nocturia and overactive bladder (OAB) symptoms and to identify clinical and health characteristics associated with nocturnal polyuria. STUDY DESIGN: Women presenting to a urogynecology clinic with complaints of nocturia and OAB symptoms were asked to participate. They completed a health characteristic summary, 3-day voiding diary, Nordic sleep questionnaire, urinary distress inventory (UDI), and a nocturia distress visual log (NDVL). The 24-hour urine production, nighttime urine volume, and maximum bladder capacity were calculated from the bladder diary. Nocturnal polyuria was defined as production of greater than 33% of the 24-hour urine volume during an 8-hour sleep period. A histogram was performed to analyze at what age the prevalence of nocturnal polyuria increased. Women were then divided by presence or absence of nocturnal polyuria and compared by the health and clinical characteristics. RESULTS: Fifty-five women met the qualifications and participated in the study. Average age of the cohort was 65.8 +/- 13.5 years. The risk of nocturnal polyuria increased with age 65 years or older (prevalence for age 65-74 = 0.86 [0.62-1.00]) and with white race. On the basis of the mean population values for UDI, NDVL, sleepiness scores, and insomnia scores, all women were bothered by their nocturia. Median number of nighttime voids, 24-hour urine production, maximum bladder capacity, nocturnal index, UDI, NDVL, sleepiness scores, and insomnia scores did not differ, based on presence or absence of nocturnal polyuria. CONCLUSION: Among women complaining of nocturia and overactive bladder symptoms, age 65 years or older and white race appear to be risk factors for nocturnal polyuria.

Racial/ethnic differences in adolescents' physical symptoms.

This study was conducted to establish race/ethnic-specific prevalence for 10 physical symptoms in American youths and to examine the extent to which socioeconomic status and depressive symptoms explained racial differences in those symptoms. This descriptive study was based on a cross-sectional analysis of survey data from Wave I of the National Longitudinal Study of Adolescent Health including a school-based sample of over 20,000 adolescents in Grades 7 through 12. Self-reported physical symptoms during the past 12 months were examined. White youths reported the highest frequency of headaches, musculoskeletal pain, and dizziness; feeling hot, chest pain, cold sweats, and urinary symptoms were more common in Black youths. The three symptoms reported by Whites remained significant after controlling for family income and depressive symptoms, whereas racial differences in the four symptoms prominent in Blacks were accounted for by family income and depressive symptoms. Findings highlight racial differences in symptom types and in psychosocial factors contributing to physical symptoms in adolescents and warn against health-care providers' stereotyping associations between physical symptoms and socioeconomic status.

Differences in prostate disease symptoms and visits to the general practitioner among three ethnic groups in New Zealand.

OBJECTIVE: To define lower urinary tract symptoms (LUTS) and their relationship to general practitioner (GP) visits and ethnicity among men in the New Zealand (NZ) population-based Wellington Region Community Prostate Study. SUBJECTS AND METHODS: In 2001-2002 NZ European, Maori and Pacific Island participants were selected from the Wellington region of NZ. Demographic questions, the International Prostate Symptom Score and yearly GP attendance questions were completed by 862 subjects with no history of prostate cancer. RESULTS: There were no significant differences in LUTS among the ethnic groups (P = 0.80) but symptom scores were positively correlated with age only for NZ Europeans (P < 0.001, r = 0.179). Overall, NZ populations have a lower prevalence of LUTS than is evident for ethnic groups in other countries. Pacific Islanders attended the GP more often than both NZ Europeans and Maori. CONCLUSION: Ethnic differences in age-related urinary symptoms and visits to the GP are important for informing culturally appropriate clinical practice and prostate health promotion with minority groups.

The natural history of lower urinary tract symptoms in black American men: relationships with aging, prostate size, flow rate and bothersomeness.

PURPOSE: Studies of lower urinary tract symptoms in men have been restricted to predominately white populations and these observations may not be generalized to black American men. A goal of the Flint Men's Health Study was to evaluate the prevalence of lower urinary tract symptoms in a community based sample of black American men. MATERIALS AND METHODS: We identified 721 eligible subjects after a 2-stage stratified sampling protocol of black American men residing in Flint, Michigan and an in-home interview. Of these men 364 (50%) completed the study protocol, including serum prostate specific antigen measurement, digital rectal examination, uroflowmetry and transrectal ultrasound. These men comprised our study group. Patients completed the American Urological Association (AUA) symptom and bothersomeness scores. Moderate to severe symptoms and impairment were defined as an AUA symptom score of greater than 7 and bothersomeness score of greater than 3, respectively. Data were stratified by 10-year age groups. RESULTS: Prostate volume increased, while the peak urinary flow rate decreased with increasing age (p <0.001). Total AUA symptom and bothersomeness scores were marginally associated with age (p = 0.08 and 0.01, respectively). Although only 8.2% of the men reported an enlarged prostate and 3% reported being on medical therapy for benign prostatic hyperplasia, moderate to severe lower urinary tract symptoms were reported by 39.6% and moderate to severe impairment was present in 35%. CONCLUSIONS: To our knowledge this is the first study to describe the prevalence of lower urinary tract symptoms and its associations with age, prostate size and peak flow rate in a black American population. A large proportion of the men in this study had from moderate to severe lower urinary tract symptoms, of whom many were undiagnosed and untreated. The AUA symptom score has the potential to identify these men and its validity in black Americans has now been established.