Psychiatric disorders in patients with lower urinary tract symptoms: A systematic review including a subgroup meta-analysis on the association between LUTS and depressive symptoms

Background: Lower urinary tracts symptoms (LUTS) – voiding symptoms, storage symptoms, or post-micturition symptoms – and psychiatric disorders are often comorbid conditions in patients. However, no systematic review on the association between urological symptoms and psychiatric symptoms in a broad sense had yet been presented. We aim to systematically review the literature on the association of lower urinary tract symptoms with psychiatric symptoms or disorders. Methods: This systematic review and meta-analysis is conducted according to the PRISMA guidelines. We searched MEDLINE, Embase (Ovid interface), CINAHL and PsycINFO (EBSCO interface) for studies published between database inception and Oct 7th, 2021. The quality of the studies was assessed with Newcastle Ottawa Quality Assessment scale. This review is registered in the PROSPERO register (CRD42021207308). Results: Of 1974 records identified, 77 studies fulfilled the inclusion criteria. 68 of these had a risk of overall bias of middle or low in the NOS bias assessment scale (Lo et al., 2014; Hamling et al., 2008) [1,2]. A positive association was found between; LUTS with depression in 31 studies, and with anxiety in 11 studies; OAB with depression in 12 studies, and with anxiety in 13 studies; nocturia with depression in 6 studies; urinary incontinence (both stress and urge) with depression in 13 studies; and voiding dysfunction with depression and anxiety in 7 studies. Conclusion: To our knowledge, this systematic review is the first to research the full range of lower urinary tract symptoms in association with psychiatrics symptoms or disorders. Results show an association between LUTS and psychiatric symptoms in a broad sense, however, most studies report on LUTS in association with depression and anxiety, and less studies report on other psychiatric symptoms or disorders. Further research to specify this will be needed to make a valid statement on specific psychiatric disorders in association with LUTS.