Symptom bother is associated with health-care-seeking beyond severity in Japanese men with lower urinary tract symptoms: a cross-sectional web survey

Lower urinary tract symptoms (LUTS) are common and reduce quality of life, yet many affected men do not seek medical care. We examined how symptom severity and patient bother relate to health-care-seeking, the reasons for not seeking care, and willingness to pay (WTP) for symptom relief in Japanese men. In a cross-sectional web survey, 3999 community-dwelling Japanese men aged 40 years or older completed the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) and rated overall symptom bother on a 0–10 scale. The primary outcome was having visited a clinic. Independent predictors of clinic visit were assessed with multivariable binary logistic regression; reasons for non-attendance, awareness of treatability, and WTP were also summarized. Overall, 44.7% of men were symptomatic and 13.7% had visited a clinic (24.1% of symptomatic men). The clinic-visit rate rose with severity (5.7% mild, 21.2% moderate, 37.5% severe IPSS), with care-seeking rising steeply across the moderate-to-severe range (a graded, dose–response pattern rather than a discrete threshold). IPSS ≥ 8 (adjusted odds ratio [aOR] 3.05), bother ≥ 3 (aOR 2.76), age ≥ 65 years (aOR 1.97), and being married (aOR 1.44) were each independently associated with clinic visit, whereas household income, presence of children, and home ownership were not. Among symptomatic non-attenders (n = 1,358), the leading reasons were attributing symptoms to aging (44.3%) and the symptoms not being bothersome enough (19.4%); 45.3% were unaware that the symptoms are treatable. WTP rose with bother: the proportion willing to pay a non-zero amount was 36%, 72%, and 90% across the none, low, and high bother groups. In Japanese men with LUTS, care-seeking was associated with both symptom severity and, independently, patient bother, and the most frequently reported barriers were the belief that symptoms are part of aging and limited awareness of treatability. As a cross-sectional web-panel survey, these are associations rather than causal or population-level estimates.