622 among cooperative behavior referrals and there were more patients older than 60 years of age than other age groups. The United Nations has defined a society with an aged pop- ulation of 7 to 14% as an aging society, a society with an aged population of 14 to 20% as an aged society, and a soci- ety with an aged population of more than 20% as an ul- tra-aged society [8]. According to the Statistics Office, Korea has already entered into an aging society, with 9.1% of the population aged over 65, and it is expected to enter into an aged society in 2018 and an ultra-aged society in 2026 [9]. According to Lee et al. [10] regarding the preva- lence of overactive bladder, urinary incontinence, and LUTS, more males over the age of 50 show LUTS than fe- males and the occurrence of LUTS in males increases with age. Such LUTS in males are caused by benign prostatic hypertrophy, which is prevalent in aged males. It is known that 40 to 70% of males over 60 have benign prostatic hyper- trophy symptoms in Western reports [11,12]. The preva- lence of benign prostatic hyperplasia increases from ap- proximately 50% at 60 years of age to 90% in men older than 85 years [13]. Looking into the departmental distribution, it was in the descending order of internal medicine, orthopedic surgery, neurosurgery, general surgery, obstetrics and gynecology, and neurology. Of these departments, the internal medi- cine department recorded 34% of referrals in the 3 years studied. The most common chronic diseases that the pa- tients in internal medicine have are diabetes and hyper- tension. In particular, metabolic syndrome is defined when diseases such as hypertension, diabetes, dyslipidemia, and obesity causing coronary artery disease are shown togeth- er [14]. It is known that the basic pathophysiology of meta- bolic syndrome may cause LUTS because of secondary hy- perinsulinemia owing to insulin resistance and over- activation of the sympathetic system [15], and abdominal fat is related to prostatic hypertrophy [16]. Additionally, urinary symptoms in the patients with obesity and dia- betes may be aggravated because of more frequent urinary tract infections owing to decreased immunity. Obesity and diabetes may cause LUTS and erectile malfunction be- cause of the dysfunction of vascular endothelial cells [17,18]. Additionally, because of the aggravated base dis- eases in internal medicine, LUTS can occur because of de- mentia or delirium. Furthermore, various medications, such as hypertension-preventive calcium channel block- ers, nasal decongestant α-adrenergic agonists, diuretic and nonsteroidal anti-inflammatory drugs for congestive heart failure, angiotensin converting enzyme inhibitors, and anticholinergics, can cause LUTS [19]. In departments where operations for nongenitourinary diseases take place, such as orthopedic surgery, neuro- surgery, general surgery, and obstetrics and gynecology, urination disorders are reported in 4 to 25% of cases after an operation using general anesthesia or spinal anesthesia [20]. According to the type of operation, the occurrence of voiding dysfunction after the operation was 26% in lapa- rotomy, 14% in herniotomy, 30% in laparocholecystotomy Korean J Urol 2012;53:619-624 Lee et al [21-23], and 28% in total hip reconstruction and total knee reconstruction [24]. In this study, compared with the other surgery departments, the rate of referrals was high in or- thopedic surgery. This may be because there were more in- patients in orthopedic surgery than in other departments and that disorders in walking were caused after the operations. When looking into the distribution by disease, urination disorder was the highest, with a rate of 61.26%. Among uri- nation disorder diseases, they were in the descending order of benign prostatic hypertrophy, neurogenic bladder, uri- nary retention, urinary incontinence, and overactive bladder. Urinary retention may easily occur in older pop- ulations because they have retarded renal function, thus concentrating the urine; reduced contraction power of the bladder; difficulties in mobility because of failed joints; changes in cognitive processes; lost integrity of the nervous system; and obstruction disease such as benign prostatic hypertrophy and uterus or bladder prolapse [25]. Additio- nally, with the lengthened hours of the operation, the amount of anesthetic and narcotic analgesic administered to the patient increases and the hydration solution amount also increases. Therefore, urinary retention may occur more easily [21]. This mainly happens in perineum, gyne- cology, and anal surgery. Urinary retention occurring after surgery may be temporary. However, urinary retention can be related to inappropriate management or lack of management of urologic problems. Additional agents used after the operation can also cause problems in urination; therefore, these patients need continuous referral to urology. In the urinary incontinence prevalence survey of the gen- eral public in Korea, the overall prevalence rate was 41.2% [26] and the rate of urinary incontinence in this study was 9.85%. According to Shin et al. [7] study regarding the prev- alence rate and management status of urinary incon- tinence among the inpatients of nursing hospitals in Busan, the reasons for admittance to a nursing hospital in- cluded cerebral vascular disease (33.8%), senile infirmity (20.3%), dementia (16.4%), immobilization (10.3%), chron- ic wasting disease (9.8%), and other diseases including Parkinson’s disease (9.4%). The prevalence rate of urinary incontinence was 48.1%, and most of the patients managed urinary incontinence by use of diapers. Complications were reported as cutaneous disorders in the inguinal region and perineum, eczema, and decubitus. It is generally thought that uncomplicated urinary tract infections can occur easily and are harmless because they can be cured with the administration of antibiotics. However, in the case of complicated urinary tract in- fections, ranging from cystitis to sepsis accompanying shock, the strain would be most frequently enterobacteria such as Escherichia coli. Compared with uncomplicated urinary tract infections, the causative strains of compli- cated urinary tract infections are much more various with high antibiotic resistance [27]. According to the clinical guidance of the European Urology Association, factors sug-