This study aimed to assess the prevalence of lower urinary tract symptoms in 5 selected low and middle-income countries to  provide appropriate evidence for other related studies.

This cross-sectional multicenter epidemiologic study was conducted in 2019 in 5 low and middle-income countries. Following field studies based on our previous systematic review on the prevalence of incontinence in developing countries, the panel of experts selected 5 developing countries to be enrolled in the study. Criteria for the selection of participant countries included: accessibility, appropriate geographical distribution, existence of a suitable statistical  system, support of national organs. Ten countries met our inclusion criteria. The panel of experts initially prioritized these countries considering the inclusion criteria. They then selected the final five  countries (i.e. Bangladesh, Brazil, Cameroon, Egypt, and Iran). The sample size was calculated based on a prevalence of 19-25% incontinence among people in developing countries in previous studies. The sampling method was a multistage cluster. After selection of the participating countries, for the evaluation of study sample which were selected from the general population;  we used standard validated and reliable questionnaires in the language of each country to evaluate lower urinary tract symptoms: ICIQ_UI_SF, ICIQ_OAB, ICIQ_FLUTS, ICIQ_MLUTS . In this study ICIQ-UI-SF questionnaire was filled for Bangladesh, Brazil, Cameron and Egypt. ICIQ- OAB questionnaire was completed for Bangladesh, Brazil and Cameron and ICIQ-MLUTS questionnaire  in Brazil and Cameron and ICIQ-FLUTs  in Bangladesh, Brazil and Iran was checked. For the data analysis, descriptive methods were used to indicate the prevalence and confidence interval.

979 participants (67.4% females and 32.6% males) from 5 countries completed the questionnaires. The mean age of participants was 41±15.3 years old. Each questionnaire were analyzed with subgroups of country, sex and age.  496 participants from 4 countries (66.6% females) completed the  ICIQ- UI -SF questionnaire of which, 37.1% reported at least one episode of urinary incontinence per week; 14% of them more than one episode per day. The average effect of incontinence on quality of life was 2.09 (CI 95%: 1.7 to 2.4 ). 386 participants from 3 countries ( 68.9% females ) completed the ICIQ-OAB questionnaire. The prevalence of frequency was 43.8% with an average symptom disturbance of 2.2 (0 to 10). Considering the ICIQ-MLUTS questionnaire that was completed by 175 males from 2 countries, nocturia (53.35%) and incomplete emptying (44.4%) were the most prevalent lower urinary tract symptoms. Incomplete emptying was reported as the most disturbing LUTS in men. Average V score (total of the 5 first questions about storage symptoms) was 3.2 (CI95%:2.5-3.8). Average I score (total of the 6 first questions about urinary incontinence) was 2.2 (CI95%:1.7-2.6). Based on ICIQ-FLUTS  questionnaire which was completed by 595 women from 3 countries, urgency (65.3%) and nocturia(64.7%) were the most abundant and the most disturbing LUTS among women. Average F score (total of 4 questions about nocturia, pain, urgency, frequency) was 3.7 (CI95%:3.3-4.1). The average V score (total of 3 questions  about storage symptoms) was 1.6 (CI95%:1.3-1.9). The Average I score ( questions about urinary incontinence) was 2.1(CI95%:1.6-2.5).

The results of the present study can be considered as a basis for health-care planning at the national, regional, and global levels. According to this study, high prevalence of urinary symptoms was reported in the selected populations, which were from low to middle-income countries.

The results of the present study can be considered as a basis for health-care planning at the national, regional, and global levels. According to this study, high prevalence of urinary symptoms was reported in the selected populations, which were from low to middle-income countries.