HIGHER levels of frailty are associated with an increased likelihood of symptomatic benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in older men, according to findings from two nationally representative population-based studies conducted in China and the USA.
The study analysed data from 8,781 men in the China Health and Retirement Longitudinal Study (CHARLS) and 2,539 men in the US National Health and Nutrition Examination Survey (NHANES). Researchers examined whether the frailty index (FI), a recognised measure of biological ageing based on accumulated health deficits, was associated with symptomatic BPH/LUTS.
Increasing Frailty Burden Tied to Greater Odds of BPH/LUTS
Among participants, 11.9% of men in the Chinese cohort and 22.0% in the US cohort met the criteria for symptomatic BPH/LUTS. After adjusting for potential confounding factors, increasing frailty was consistently associated with a higher likelihood of urinary symptoms in both populations.
Each increase in the log-transformed frailty index was associated with a 91% increase in the odds of BPH/LUTS in the CHARLS cohort (odds ratio [OR] 1.91; 95% confidence interval [CI] 1.71–2.13) and a 47% increase in the NHANES cohort (OR 1.47; 95% CI 1.25–1.73).
The researchers also observed a graded relationship between frailty and urinary symptoms. Men in the highest frailty tertile were nearly three times more likely to have BPH/LUTS than those in the lowest tertile in the Chinese cohort (OR 2.91; 95% CI 2.39–3.56) and almost twice as likely in the US cohort (OR 1.77; 95% CI 1.32–2.37). Statistical modelling suggested the relationship was linear, with no evidence that risk plateaued or accelerated at higher frailty levels.
Subgroup analyses indicated that the strength of the association varied according to drinking status in the Chinese cohort and age and smoking status in the US cohort, suggesting lifestyle and demographic factors may influence the relationship between frailty and urinary symptoms.
As a supplementary analysis, the investigators developed machine-learning models to assess risk stratification. These models demonstrated good internal predictive performance, although the authors caution that they have not yet undergone external validation.
Longitudinal Studies Needed to Establish Causality
The researchers conclude that frailty burden is consistently associated with symptomatic BPH/LUTS across diverse populations. However, because the study was cross-sectional, it cannot establish whether frailty contributes to urinary symptoms or vice versa. They call for longitudinal studies to determine the direction of this relationship and to explore whether frailty assessment could help identify men at greater risk of clinically significant BPH/LUTS.
Reference
Wu G et al. Frailty burden and symptomatic BPH/LUTS in aging men: evidence from two nationally representative population-based studies. World J Urol. 2026;44:492.
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