In a free healthcare system, why do men not consult for lower urinary tract symptoms (LUTS)?

A convenience sample of 549 male patients aged 40-85 years in a government health centre filled in the International Prostate Symptoms Scale (IPSS) questionnaire. They were also asked if they had consulted doctors for LUTS, and if not, why not.Of the whole sample, 64 men (11.7%) had ever consulted doctors for LUTS. Of 145 with moderate to severe LUTS, 35 (24.1%) consulted. Of 73 who were dissatisfied with their quality of life, 22 (30.1%) consulted. Regarding the symptoms as normal or not problematic was the main reason for not consulting. Advancing age and duration of symptoms were the significant factors for consulting.Primary care doctors could help many of LUTS patients by sensitively initiating the discussion when these patients consult for other problems.Lower urinary tract symptoms (LUTS) are common in men aged 40 years or above [1,2]. The reported prevalence of LUTS varies widely among different age groups and ethnic populations. For men aged 40 or above, the prevalence of moderate to severe LUTS was reported to be: 16.2% (Korea) [3], 19.2% (France) [3], 20.7% (Netherlands) [3], 25.1% (UK) [3], 38% (USA) [4], 56% (Japan) [4]. For men aged 50 or above, the reported rates were: 28% (Denmark) [5], 14% (Singapore) [6], 34% (Malaysia) [6], 39% (Thailand) [6], 41% (UK) [7], 48% (Hong Kong) [6], 59% (Philippines) [6]. These reports used the International Prostate Symptom Score (IPSS) that was validated in different languages to assess the presence and severity of LUTS, and the recruits were from the community-population. Some of them were done concurrently in different countries [3,4,6]. Given that the prevalence of LUTS differs among different populations, more data are required to see if the rates differ even within the same ethnic population.Though commonly affected, not many men with LUTS consult their doctors for these symptoms. The reported rates vary also widely: 4.4% (US) [8], 9.2% (Denmark) [5], 11.3% (Scotland) [9], 18% (UK) [7], 22.2% (African-American)