The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: A systematic review and meta-analysis of observational studies

Sean A. Martin, Phillip J. Tully, Arman A. Kahokehr, Alex Jay, Gary A. Wittert

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


Background: Recent evidence from observational studies suggests a bidirectional association between lower urinary tract symptoms (LUTS) and depression in men. We sought to systematically quantify the effect of the presence of LUTS on depression symptoms, compared to those without LUTS, in adult males, and vice versa. Methods: Electronic databases (MEDLINE, PsycINFO, SCOPUS, Embase) were examined for articles in English before March 2021. Observational studies of men aged over 18 years; reporting an association between LUTS and depression; including a validated scale for LUTS and depression symptoms were eligible for study inclusion. Results: Seventeen studies out of 1787 records identified 163 466 men with reported depression symptoms by LUTS status, while 10 studies reported 72 363 men with LUTS by depression symptoms. Pooled estimates showed a strong effect of LUTS presence on depression risk (OR: 2.89, 95% CI: 2.50–3.33), with a high degree of heterogeneity among the examined studies (I2 = 83%; τ2 = 0,06; p < 0.001). Subgroup analyses demonstrated differences by study region (Q value:13.7, df:4, p = 0.003), setting (7.8(2), p = 0.020), design (7.2(1), p = 0.003), quality (6.2(1), p = 0.013), and LUTS measure (40.9(3), p < 0.001). Pooled estimates also showed a strong effect of depression presence on LUTS risk in men (OR: 3.13, 95% CI: 2.72–3.60), with only moderate heterogeneity between studies (I2 = 58%; τ2 = 0,02; p = 0.001). Conclusions: The strong relationship observed between LUTS and depression implies shared risk factors that cannot be solely attributed to the prostate. This has immediate implications for future studies and the assessment and management of patients with either condition.

Original languageEnglish
Pages (from-to)552-561
Number of pages10
JournalNeurourology and Urodynamics
Issue number2
Publication statusPublished or Issued - Feb 2022


  • depressive symptoms
  • lower urinary tract symptoms
  • systematic review

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

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