Journal of the Formosan Medical Association (2019) 118, 170e178

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Original Article

The prevalence and bother of lower urinary

tract symptoms in men and women aged 40
years or over in Taiwan
Shih-Ping Liu a, Yao-Chi Chuang b,*, Budiwan Sumarsono c,
Hui-Chen Chang d

a
Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
b
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of
Medicine, Kaohsiung, Taiwan
c
Astellas Pharma Singapore Pte. Ltd., Singapore
d
Astellas Pharma Taiwan, Inc., Taiwan

Received 10 October 2017; received in revised form 29 January 2018; accepted 9 March 2018

KEYWORDS Background/Purpose: The prevalence of lower urinary tract symptoms (LUTS) in men and
Lower urinary tract women in the general population in Taiwan is unclear. Community-based data on the epidemi-
symptoms; ology and effects of LUTS would therefore help improve understanding of the condition in this
Overactive bladder; country.
Prevalence; Methods: This study was an internet-based, self-administered survey, conducted in randomly
Taiwan selected adults aged
40 years. Participants answered questions on International Continence
Society (ICS) symptom definitions, the International Prostate Symptom Score (IPSS) and the
overactive bladder (OAB) symptom score.
Results: The study population comprised 2068 adults (51.4% women) with a mean age of 55
years. Using criteria from the ICS, LUTS were present in 60% of men and 57% of women. The
prevalence of LUTS increased with age in both men and women. The most bothersome symp-
toms were terminal dribble, incomplete emptying and nocturia in men, and nocturia,
perceived frequency and urgency in women. In the overall population, according to IPSS,
30% had at least moderate symptoms. OAB prevalence was 16% in both men and women.
The likelihood of consulting a healthcare professional about urinary symptoms was low and
not significantly different between men and women with LUTS (17% and 14%, respectively).
Conclusion: More than half of men and women aged
40 years in Taiwan are affected by LUTS,
and these symptoms are often bothersome. However, few individuals with LUTS consult

* Corresponding author. Fax: þ886 7 731 8762.

E-mail address: chuang82@ms26.hinet.net (Y.-C. Chuang).

https://doi.org/10.1016/j.jfma.2018.03.006
0929-6646/Copyright ª 2018, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
LUTS prevalence in Taiwan
healthcare professionals about their symptoms. Improved diagnosis and treatment of LUTS in
Taiwan are needed to reduce the deleterious effects of the condition.
ClinicalTrials.gov identifier: NCT02618421.
Copyright ª 2018, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
Introduction
The most widely accepted definition of lower urinary tract
symptoms (LUTS) has been published by the International
Continence Society (ICS), which classifies symptoms into
three groups: storage, voiding and post-micturition.1 In-
ternational studies have estimated that LUTS affect at least
60% of adults.2e4 However, prevalence rates are variable
because studies differ, for example in the definition of LUTS
and the population being studied (e.g. with respect to sex,
age or comorbidities). Previous data have shown that
voiding symptoms are more common in men than women,
that storage symptoms are more common in women than
men, and that overall LUTS prevalence is similar in both
sexes.2,3
The impact of LUTS on individuals’ everyday life can be
significant, with distress and reduced confidence poten-
tially reducing work-related productivity and social inter-
action.5e7 Reduced quality of life has been reported among
individuals with LUTS, and the likelihood of depression and
anxiety is increased.8e10 LUTS also have an important
financial impact, principally due to reduced work activ-
ities.11,12 For example, in the USA, the annual total cost of
overactive bladder (OAB) was estimated in 2009 to be $24.9
billion.12 Therefore, there is adequate scope for treatment
to be cost-effective if it reduces the impact of symptoms.
No major studies have measured LUTS prevalence in
both men and women in the general population in Taiwan.
Therefore, we have little knowledge of differences be-
tween the sexes in the frequency and bother of symptoms.
Community-based data on the epidemiology and effects of
LUTS would therefore help improve understanding of the
condition in Asia.
Methods
This study forms part of a larger study on the prevalence
and impact of LUTS and OAB in three Asian countries and
the methodology has been published in full previously;4
therefore, it is described only briefly here. Study partici-
pants were aged at least 40 years, with the ability to read
the local language and to access the internet. Study par-
ticipants were selected randomly within survey panels,
with active management to ensure an appropriate de-
mographic profile (age, gender, socioeconomic factors). All
participants provided informed consent. The study
comprised an internet-based, self-administered survey. It
was begun on 2 June 2015 and completed on 20 July 2015.
Participants answered questions on ICS symptom defini-
tions, the International Prostate Symptom Score (IPSS) and
171
the overactive bladder symptom score (OABSS). Visits to
healthcare professionals were also documented.
The primary study objective was to assess LUTS preva-
lence according to the ICS 2002 symptom definition, except
for nocturia, which was identified by
2 nightly micturitions
instead of one per night. Prevalence of OAB according to
OABSS, and prevalence of LUTS according to IPSS were sec-
ondary objectives. Symptom-specific bother of LUTS was
assessed using a 5-point Likert scale: not at all (score 0), a
little bit (score 1), somewhat (score 2), quite a bit (score 3) or
a great deal (score 4). A score <2 suggested that the degree
of bother was none or only small, while a score
2 indicated
‘somewhat’ or greater bother and the most severe degree of
bother score
3 was classed as ‘quite a bit’ or greater bother.
Descriptive statistics were used for the initial data analyses.
The chi-square test was used for post hoc statistical com-
parisons, except for the relationships between age and LUTS
prevalence (analyzed using analysis of variance), and body
mass index (BMI) and LUTS (analyzed using an independent-
samples t-test to determine equality of means).
Results
In total, 2068 adults from Taiwan participated in the study
(Table 1). Numbers of men and women were well balanced
with a mean age of 55 years. Most participants were mar-
ried or living with a partner, and most were in full-time
employment.
Using ICS criteria, LUTS were present in 59% of the overall
population, with a slightly higher percentage of men than
women affected (60% vs. 57%) (Fig. 1). In men and the overall
population, the most common combination of ICS symptom
categories was all three groups (voiding plus storage plus post-
micturition). In women, the most common LUTS category was
storage symptoms only, and all three symptom groups was the
second most common combination. The combination of all
three symptom groups and voiding symptoms only were more
common in men than women, while storage symptoms only
were more common in women. The prevalence of LUTS
increased with successive age groups (Fig. 2; p < 0.001 for the
overall population). LUTS were more prevalent among in-
dividuals with versus those without a range of comorbidities
(Fig. 3). The highest LUTS prevalence was observed in those
with diabetes, cardiac disease and hyperlipidemia. A signifi-
cant interaction was found between LUTS and all comorbid
conditions except neurological disease or smoking. There was
no significant difference in BMI in those with LUTS
(mean Z 24.1, standard deviation [SD] 4.1) versus those
without LUTS (mean 23.7, SD 3.6); t(2066) Z 1.9, p Z 0.063.
Individual symptoms affecting the largest percentages of
the overall population were nocturia, incomplete emptying
172 S.-P. Liu et al.

Table 1 Demographics and baseline characteristics of the Taiwanese study participants. Table adapted from Chapple et al.
2017.4
Variable Men þ Women Men Women p
No. of participants 2068 1005 1063
Mean (SD) age, years 55.16 (28.5) 51.86 (27.4) 58.69 (29.3) <0.001a
Marital status, n (%)
Married/living with partner 1505 (72.8) 768 (76.3) 737 (69.3) <0.001b
Single 309 (14.9) 141 (14.0) 168 (15.8)
Widow/widower 131 (6.3) 29 (2.9) 102 (9.6)
Divorced 108 (5.2) 60 (6.0) 48 (4.5)
Prefer not to answer 16 (0.7) 8 (0.8) 8 (0.8)
Education, n (%)
High school or less 813 (39.3) 307 (30.5) 506 (47.6) <0.001b
Some college 491 (23.7) 234 (23.3) 257 (24.2)
College degree/college graduate 583 (28.2) 331 (32.9) 252 (23.7)
Postgraduate 181 (8.8) 133 (13.2) 48 (4.5)
Work status, n (%)
Working, full-time 1242 (60.0) 694 (68.8) 548 (51.6) <0.001b
Working, part-time 128 (6.2) 50 (5.0) 78 (7.3)
Unemployed 27 (1.3) 14 (1.4) 13 (1.2)
Retired 349 (16.9) 197 (19.5) 152 (14.3)
Homemaker 249 (12.0) 15 (1.5) 234 (22.0)
Other work for pay 16 (0.8) 11 (1.1) 5 (0.5)
Permanently disabled/cannot 17 (0.8) 9 (0.9) 8 (0.8)
work due to ill health
Student 3 (0.1) 1 (0.1) 2 (0.2)
Other 39 (1.9) 17 (1.7) 22 (2.1)
a
p value: determined from analysis of variance (ANOVA); bp value: determined from chi-square test for proportions.
If p value is less than 0.05 then difference between the groups considered to be statistically significant. Numbers of individuals are
weighted and rounded, and hence may not add up; percentages are based on the weighted ‘n’ values.

and perceived frequency (32%, 26% and 22%, respectively).
Based on percentages of individuals experiencing ‘quite a bit’
or greater bother, nocturia and terminal dribble were the
most bothersome symptoms. In men, nocturia and incom-
plete emptying were the most common symptoms, both
affecting 31% of individuals (Fig. 4). In women, nocturia was
the most common symptom (present in 32% of individuals) and
perceived frequency was second most common (24%) (Fig. 4).
Prevalence rates for split stream, terminal dribble and post-
micturition incontinence or dribble were significantly higher
in men than women. Conversely, stress urinary incontinence
(laughing, sneezing and coughing) were significantly more
prevalent in women versus men. The most bothersome
symptoms in men were terminal dribble, incomplete
emptying and nocturia, while in women the most bothersome
symptoms were nocturia, perceived frequency and urgency.
In the overall population, according to IPSS, 85% of in-
dividuals had at least mild LUTS and 30% had at least
moderate symptoms (Fig. 1B). The prevalence of moderate
and severe symptoms was slightly higher in men than
women, while mild symptoms were slightly more common
in women than men. Total percentages of individuals with/
without IPSS symptoms were similar in both sexes.
OAB was present in 16% of the overall population
(Fig. 1C) with little difference between men and women. As
shown in Fig. 5, compared with individuals without
comorbidities, OAB was more common in populations with
any of the comorbidities investigated. The highest OAB
prevalence was observed among individuals with
neurological disease. A significant interaction was found
between OAB prevalence and all comorbid conditions.
Only 3% of study participants without LUTS reported
consulting a healthcare professional regarding urinary
symptoms (Supplementary Fig. 1A), compared with 16% of
those with LUTS. Corresponding percentages in men were
2% and 17%, and in women they were 5% and 14%. There was
no significant difference between men and women in the
likelihood of seeking treatment. Individuals with all three
ICS symptom groups (voiding plus storage plus post-
micturition) were most likely to visit a healthcare profes-
sional in relation to urinary symptoms. All of the comor-
bidities investigated in this study were associated with an
increased likelihood of consulting healthcare professionals
about urinary symptoms (Supplementary Fig. 1B). Comor-
bidities associated with the greatest increases were dia-
betes, hypertension and neurological disorders.
As shown in Supplementary Table 1, the most commonly
used LUTS treatments were prescribed medicine and limiting
fluid intake. These were most common among individuals
with all three ICS symptom categories and those with storage
symptoms only, as well as the overall population. Large
numbers of individuals with LUTS (28e75%) were not
following any treatment. Treatment patterns were broadly
similar in men and women (data not shown). Prescribed
medicines were being taken for LUTS by 23% of all men in the
study compared with 16% of women, while 17% of men and
22% of women were treated by limiting fluid intake. Also,
pads were worn by 3% of women versus 1% of men.
LUTS prevalence in Taiwan 173

Figure 1 Prevalence of lower urinary tract symptoms (LUTS) in Taiwan based on International Continence Society (ICS) definition
(A), International Prostate Symptom Score (IPSS) (B), and overactive bladder symptom score (OABSS) (C). PM, post-micturition.
174 S.-P. Liu et al.

Figure 2 Prevalence of lower urinary tract symptoms (based on International Continence Society definition) in Taiwan by age.

Figure 3 Prevalence of lower urinary tract symptoms (LUTS) in Taiwan: individuals with and without comorbid conditions.
a
N Z 2069 for diabetes, hypertension, hyperlipidemia.

Discussion according to IPSS. LUTS were slightly more common in men

In this first population-based study of LUTS prevalence in
both men and women aged
40 years in Taiwan, the overall
prevalence of LUTS according to ICS criteria was 58.5%,
with 30% of individuals having at least moderate symptoms
than women, and there were some differences between the
sexes regarding which symptoms were most common. The
prevalence of LUTS increased with increasing age in both
sexes. Our study used a conservative definition of nocturia
(
2 episodes per night) rather than the ICS definition of
LUTS prevalence in Taiwan 175

Figure 4 Prevalence of specific symptoms and bother caused by lower urinary tract symptoms in Taiwan: men (A) and women (B).
Score <2: no or a little bit of bother; score
2: somewhat or greater bother; score
3: quite a bit or greater bother.
176
Figure 5 Prevalence of overactive bladder (OAB) in Taiwan: individuals with and without comorbid conditions.
hypertension; N Z 2069 for hyperlipidemia.

1 episode per night. This was to avoid the possibility of an
artificially high rate, yet nocturia remained the most
common symptom and the most bothersome (with terminal
dribble). These findings are in line with previous observa-
tions that nocturia and nocturnal enuresis have a major
impact on sleep and quality of life.13,14
Most of the ICS symptom groups and combinations
thereof were more common in men than women. The
exception was storage symptoms alone, which were more
common in women. This finding is in line with previous
studies which showed that storage symptoms are more
common in women2,3 and is related to the fact that stress
urinary incontinence occurs more frequently in women than
men.15 All three ICS categories (voiding plus storage plus
post-micturition) was the most common prevalence group
in men and the second most common group in women,
showing that many individuals had multiple symptoms. OAB
was reported in fewer individuals than the ICS category of
storage symptoms. As OAB is a sub-set of ICS-defined stor-
age symptoms, this was as expected.
OAB was present in 16% of the overall population, with
similar prevalence rates in men and women. Such similarity
between the sexes has been observed previously, but this
does not mean that everything is equal in men and women
regarding OAB. For example, OAB symptoms can be trig-
gered or worsened by benign prostatic hyperplasia in men,
and by pregnancy, childbirth or the menopause in wom-
en.16e18 Also, the relationship between OAB prevalence and
age appears to be different in men and women.17 There-
fore, observations of similar OAB prevalence in men and
women could be regarded as coincidence rather than a sign
of equivalence.
Data from some studies suggest LUTS prevalence may be
higher than the present survey. Moderate-to-severe IPSS
S.-P. Liu et al.
a
N Z 2067 for
symptoms affected 50% of Taiwanese men aged
40 years
in a study by Chen et al.19 compared with 33.5% in men in
our study. A community-based study in women reported
that OAB affects 21e35% of individuals, depending on
symptom classifications,20 whereas 15.9% of women re-
ported OAB symptoms in our study. In Matsu, Taiwan, age-
adjusted prevalence of OAB was estimated as 17%,21
while a study of individuals aged
40 years in Pingtung,
Taiwan reported an OAB prevalence of 20%.22 A cross-
sectional study performed in a population aged
40 years
in Pingtung County, Taiwan showed that the prevalence of
nocturia (
2 episodes/night) was 38%.23 However, other
studies have reported lower prevalence rates. In a study of
Taiwanese women, LUTS were present in 45% of indigenous
women and 31% of non-indigenous women.24 Apart from
using IPSS for the primary assessment of LUTS, this study
differed from the present one by including younger in-
dividuals aged over 18 years. A survey of adult men in the
Hualien district reported moderate-to-severe IPSS-defined
LUTS in 13% of aborigines and 9% of non-aborigines.25
Finally, a cross-sectional study of almost 15,000 adults
aged
18 years found that 6% of the population had OAB
(urgency at least once per week).26
We found that a range of comorbidities were associated
with higher rates of LUTS. Individuals with comorbidities
were also more likely to have OAB than those without
comorbidities. These results were as expected and are
consistent with existing knowledge of LUTS. Diabetes has
previously been associated with increased rates of LUTS.27
A study of women in Taiwan showed that obesity and car-
diac disease were associated with increased prevalence of
urinary incontinence.28 Previous studies in Taiwan have
identified older age, obesity, diabetes mellitus and alcohol
consumption as risk factors for OAB.20,21,29 In another
LUTS prevalence in Taiwan
Taiwanese epidemiological study, statistically significant
associations were observed between OAB and heart dis-
ease, stroke, constipation and urinary tract infection.22 The
authors considered each of these conditions as more likely
to cause OAB than vice versa.
We observed higher overall rates of healthcare consul-
tation in men and women with LUTS compared with those
without LUTS. This is consistent with a previous study by Wu
et al. in Taiwanese women, which showed increased hos-
pital admissions among those with versus without LUTS.30
Wu et al. suggested that LUTS may be associated with
increased rates of comorbidities or a decreased threshold
for healthcare consultation. Accordingly, there is evidence
of increased rates of hypertension, diabetes, acute car-
diovascular events, stroke and dementia among individuals
with LUTS,22,31,32 and significantly increased rates of uri-
nary incontinence and urinary frequency have been
observed in Taiwanese women with diabetes and
hypertension.33,34
The proportion of individuals with LUTS in our study who
visited healthcare professionals because of their urinary
symptoms was low (17% in men and 14% in women). How-
ever, the number of individuals in Taiwan seeking health-
care for LUTS has been increasing and also increases with
age, potentially due to breaking down some of the multiple
psychological and cultural barriers that limit health-seeking
behavior.35 It has been observed that individuals who seek
healthcare for LUTS subsequently have significantly
increased rates of outpatient visits and hospitalizations,
compared with individuals not presenting with LUTS.36
Although this represents a burden on the healthcare sys-
tem, the expectation that consultations lead to more
effective treatment of LUTS means that the overall burden
should be reduced.
Overall, there is an important need to encourage more
individuals with LUTS to seek healthcare. One approach
would be an educational program to increase awareness of
LUTS and highlight the benefits of effective treatment. The
most bothersome symptoms are likely to trigger individuals
to seek healthcare. Our study shows that these differ be-
tween men and women, suggesting that educational pro-
grams may need to be tailored differently for the two
sexes.
The main strengths of this study are the large sample
size, and the use of a range of well-established and vali-
dated assessments. Another strength is the high internet
penetration rate in Taiwan (84% at the time of the study;
http://www.internetworldstats.com/asia.htm#tw), which
limits the scope for bias due to administering the study
via the internet. Limitations include lack of information
to show the extent of coverage across Taiwan, and
possible misinterpretations of questions in the absence of
face-to-face contact between study participants and the
investigators. The use of a volunteer consumer survey panel
may have resulted in potential bias towards individuals of a
higher socioeconomic class or educational level. Such social
and economic factors are known to influence individuals’
knowledge and understanding of healthcare issues.37,38
In conclusion, 60% of men and 57% of women in Taiwan
aged
40 years are affected by LUTS. In men and the
overall population, the most common combination of ICS
symptom categories was all three groups (voiding plus
177
storage plus post-micturition), while in women the most
common LUTS category was storage symptoms only. This
study confirms that the prevalence of LUTS increases with
age in both men and women in Taiwan. LUTS prevalence is
also increased among populations with comorbidities such
as diabetes, hypertension and neurological disorders.
Although many individuals experience multiple and both-
ersome symptoms, the likelihood of consulting a healthcare
professional about urinary symptoms was low and not
significantly different between men and women. In-
dividuals with LUTS who do not seek professional health-
care for their symptoms may not be receiving the most
effective treatment available. Hence, a greater education
of the general population regarding LUTS symptoms, diag-
nosis and treatment could reduce the effects of the con-
dition, ultimately improving quality of life.
Funding/Support
This study was funded by Astellas Pharma Singapore Pte.
Ltd. Editorial support, including writing assistance, was
provided by Ken Sutor BSc and Jackie van Bueren BSc of
Envision Scientific Solutions, funded by Astellas Pharma
Global Development.
Conflicts of interest
S-PL and Y-CC acted as consultants for Astellas during a
meeting to discuss publications from the study.
BS is an employee of Astellas Pharma Singapore Pte.
Ltd., Singapore.
H-CC is an employee of Astellas Pharma Taiwan, Inc.,
Taiwan.
Acknowledgments
The authors would like to thank the participants of the
study for their time, and Nanjangud Shankar Narasimha
Murthy and Raviprakash Koni, Stratycon Business Solutions
Pvt. Ltd., Bangalore, India for statistical analyses.
Appendix A. Supplementary data
Supplementary data related to this article can be found at
https://doi.org/10.1016/j.jfma.2018.03.006.
References
1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U,
et al. The standardisation of terminology of lower urinary tract
function: report from the Standardisation Sub-committee of
the International Continence Society. Neurourol Urodyn 2002;
21:167e78.
2. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS,
et al. The prevalence of lower urinary tract symptoms (LUTS)
in the USA, the UK and Sweden: results from the Epidemiology
of LUTS (EpiLUTS) study. BJU Int 2009;104:352e60.
3. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S,
et al. Population-based survey of urinary incontinence,
178
overactive bladder, and other lower urinary tract symptoms in
five countries: results of the EPIC study. Eur Urol 2006;50:
1306e14.
4. Chapple C, Castro-Diaz D, Chuang YC, Lee KS, Liao L, Liu SP,
et al. Prevalence of lower urinary tract symptoms in China,
Taiwan and South Korea: results from a cross-sectional, pop-
ulation-based study. Adv Ther 2017;34:1953e65.
5. Aguilar-Navarro S, Navarrete-Reyes AP, Grados-Chavarria BH,
Garcia-Lara JM, Amieva H, Avila-Funes JA. The severity of
urinary incontinence decreases health-related quality of life
among community-dwelling elderly. J Gerontol A Biol Sci Med
Sci 2012;67:1266e71.
6. Tang DH, Colayco DC, Khalaf KM, Piercy J, Patel V, Globe D,
et al. Impact of urinary incontinence on healthcare resource
utilization, health-related quality of life and productivity in
patients with overactive bladder. BJU Int 2014;113:484e91.
7. Wang YH, Chen SH, Jou HJ, Tsao LI. Doing the best to control:
the experiences of Taiwanese women with lower urinary tract
symptoms. Nurs Res 2011;60:66e72.
8. Martin S, Vincent A, Taylor AW, Atlantis E, Jenkins A,
Januszewski A, et al. Lower urinary tract symptoms, depres-
sion, anxiety and systemic inflammatory factors in men: a
population-based cohort study. PLoS One 2015;10:e0137903.
9. Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL,
Kopp ZS, et al. The burden of lower urinary tract symptoms:
evaluating the effect of LUTS on health-related quality of life,
anxiety and depression: EpiLUTS. BJU Int 2009;103(Suppl. 3):
4e11.
10. Robertson C, Link CL, Onel E, Mazzetta C, Keech M, Hobbs R,
et al. The impact of lower urinary tract symptoms and
comorbidities on quality of life: the BACH and UREPIK studies.
BJU Int 2007;99:347e54.
11. Levy R, Muller N. Urinary incontinence: economic burden and
new choices in pharmaceutical treatment. Adv Ther 2006;23:
556e73.
12. Onukwugha E, Zuckerman IH, McNally D, Coyne KS, Vats V,
Mullins CD. The total economic burden of overactive bladder in
the United States: a disease-specific approach. Am J Manag
Care 2009;15:S90e7.
13. Chen SL. Nocturia: a nonspecific but bothersome symptom in
urology. Urol Sci 2011;22:1e6.
14. Lee D, Dillon BE, Lemack GE. Adult onset nocturnal enuresis:
identifying causes, cofactors and impact on quality of life. Low
Urin Tract Symptoms 2017 July 3. https://doi.org/10.1111/
luts.12183 [Epub ahead of print].
15. Chen GD, Ng SC, Chang C. Gender differences in coping stra-
tegies for troublesome lower urinary tract symptoms prior to
seeking treatment. J Gen Practice 2014;2:181.
16. Palma T, Raimondi M, Souto S, Fozzatti C, Palma P, Riccetto C.
Prospective study of prevalence of overactive bladder symp-
toms and child-bearing in women of reproductive age. J Obstet
Gynaecol Res 2013;39:1324e9.
17. Eapen RS, Radomski SB. Review of the epidemiology of over-
active bladder. Res Rep Urol 2016;8:71e6.
18. Tomaszewski J. Postmenopausal overactive bladder. Prz Men-
opauzalny 2014;13:313e29.
19. Chen TI, Hsu YS, Wu TT. Lower urinary tract symptoms and
uroflow in a community-based sample of Taiwanese men. J
Chin Med Assoc 2003;66:84e8.
20. Chen YC, Ng SC, Chen SL, Huang YH, Hu SW, Chen GD. Over-
active bladder in Taiwanese women: re-analysis of epidemio-
logical database of community from 1999 to 2001. Neurourol
Urodyn 2012;31:56e9.
21. Yu HJ, Liu CY, Lee KL, Lee WC, Chen TH. Overactive bladder
syndrome among community-dwelling adults in Taiwan:
S.-P. Liu et al.
prevalence, correlates, perception, and treatment seeking.
Urol Int 2006;77:327e33.
22. Chiu AF, Huang MH, Wang CC, Kuo HC. Prevalence and factors
associated with overactive bladder and urinary incontinence in
community-dwelling Taiwanese. Tzu Chi Med J 2012;24:
56e60.
23. Huang MH, Chiu AF, Wang CC, Kuo HC. Prevalence and risk
factors for nocturia in middle-aged and elderly people from
public health centers in Taiwan. Int Braz J Urol 2012;38:
818e24.
24. Chuang FC, Kuo HC. Prevalence of lower urinary tract symp-
toms in indigenous and non-indigenous women in Eastern
Taiwan. J Formos Med Assoc 2010;109:228e36.
25. Kuo HC. Prevalence of lower urinary tract symptoms in male
aborigines and non-aborigines in eastern Taiwan. J Formos Med
Assoc 2008;107:728e35.
26. Wang Y, Xu K, Hu H, Zhang X, Wang X, Na Y, et al. Prevalence, risk
factors, and impact on health related quality of life of over-
active bladder in China. Neurourol Urodyn 2011;30:1448e55.
27. Tai HC, Chung SD, Ho CH, Tai TY, Yang WS, Tseng CH, et al.
Metabolic syndrome components worsen lower urinary tract
symptoms in women with type 2 diabetes. J Clin Endocrinol
Metab 2010;95:1143e50.
28. Tsai YC, Liu CH. Urinary incontinence among Taiwanese
women: an outpatient study of prevalence, comorbidity, risk
factors, and quality of life. Int Urol Nephrol 2009;41:795e803.
29. Liu RT, Chung MS, Lee WC, Chang SW, Huang ST, Yang KD, et al.
Prevalence of overactive bladder and associated risk factors in
1359 patients with type 2 diabetes. Urology 2011;78:1040e5.
30. Wu MP, Su TH. Do lower urinary tract symptoms (LUTS) pre-
dispose the individuals to more admissions in Taiwanese
women? - A preliminary report. Taiwan J Obstet Gynecol 2012;
51:402e4.
31. Chiang CH, Wu MP, Ho CH, Weng SF, Huang CC, Hsieh WT, et al.
Lower urinary tract symptoms are associated with increased
risk of dementia among the elderly: a nationwide study. Bio-
med Res Int 2015;2015:187819.
32. Lin HJ, Weng SF, Yang CM, Wu MP. Risk of hospitalization for
acute cardiovascular events among subjects with lower urinary
tract symptoms: a nationwide population-based study. PLoS
One 2013;8:e66661.
33. Hsieh CH, Chen HY, Hsu CS, Chang ST, Kuo TC, Chiang CD. Risk
factors for urinary frequency in Taiwanese women aged 20-59
years. Taiwan J Obstet Gynecol 2006;45:329e32.
34. Hsieh CH, Lee MS, Lee MC, Kuo TC, Hsu CS, Chang ST. Risk
factors for urinary incontinence in Taiwanese women aged 20-
59 years. Taiwan J Obstet Gynecol 2008;47:197e202.
35. Wu MP, Hsu YW, Weng SF, Ho CH, Wang JJ, Tong YC. Health-
care-seeking prevalence of lower urinary tract symptoms
among national health insurance enrollees in Taiwan, 2000-
2009. Urology 2013;81:61e5.
36. Wu MP, Weng SF, Hsu YW, Wang JJ, Kuo HC. Medical attendance
for lower urinary tract symptoms is associated with subsequent
increased risk of outpatient visits and hospitalizations based on
a nationwide population-based database. PLoS One 2013;8:
e57825.
37. Fowke JH, Munro H, Signorello LB, Blot WJ, Penson DF. Urologic
Diseases of America Project. Association between socioeco-
nomic status (SES) and lower urinary tract symptom (LUTS)
severity among black and white men. J Gen Intern Med 2011;
26:1305e10.
38. Kubik K, Blackwell L, Heit M. Does socioeconomic status
explain racial differences in urinary incontinence knowledge?
Am J Obstet Gynecol 2004;191:188e93.