White Matter Hyperintensities Are Associated With Bladder Storage and Voiding Dysfunction in Older Adults—Results From the OSTOAP Study

PURPOSE: To investigate the relationship between age-related white matter hyperintensities (WMHs) and lower urinary tract symptoms (LUTS) in functionally independent older adults by integrating neurological and urological evaluations. MATERIALS AND METHODS: This observational prospective cohort study (One Step Towards Overactive Bladder Phenotyping [OSTOAP Study]) included 59 community-dwelling individuals aged ≥ 55 years with MRI evidence of cerebral small vessel disease. Participants underwent standardized neurological evaluation, Montreal Cognitive Assessment (MoCA), and WMH classification using the Fazekas scale. WMHs were categorized into mild (Fazekas 1) and moderate-to-severe (Fazekas 2-3). Urological assessment included validated questionnaires, a 3-day bladder diary, uroflowmetry, and post-void residual (PVR) measurement. Multivariable regression models identified predictors of LUT dysfunction. RESULTS: Participants with moderate-to-severe WMHs had more urgency episodes (median [IQR]: 3 [1-4] vs. 1 [0-2], p = 0.001) and higher PVR volumes (median [IQR]: 50 [0-90] vs. 0 [0-20], p = 0.012). WMH burden independently predicted urgency (OR = 3.51; p = 0.014) and PVR ≥ 50 mL (OR = 3.25; p = 0.014), after adjusting for age, MoCA, and comorbidities. Questionnaire scores and prostate volume did not differ significantly. Increasing age was associated with reduced maximum voided volume (β = -0.516, p < 0.001). CONCLUSIONS: Moderate-to-severe WMHs are independently associated with urgency and impaired bladder emptying. These findings suggest that cerebral small vessel disease may contribute to LUT dysfunction in older adults and support the inclusion of neurological screening in their evaluation, reinforcing the value of integrative phenotyping in future studies.