Systematic review and meta-analysis identify significant relationships between clinical anxiety and lower urinary tract symptoms.
BACKGROUND
Lower urinary tract symptoms (LUTS), such as voiding symptoms, overactive bladder, and interstitial cystitis, and anxiety disorders are often comorbid conditions in patients. However, the existing evidence regarding the rates and nature of the co-occurrence of these conditions has not been systematically evaluated. The aim of this study was to examine these relationships.


METHODS
We conducted a systematic review and meta-analysis to examine the relationship between LUTS and anxiety. We searched for articles published from January 1990 to July 2019 in PubMed, CENTRAL, PsycINFO, and Google Scholar. Outcomes were anxiety-related disorders and symptoms (clinically significant anxiety) and LUTS. We performed random-effects meta-analyses, inspected funnel plots, and applied the Egger's test to evaluate publication bias. We followed PRISMA guidelines and recorded our protocol on PROSPERO (ID = CRD42019118607).


RESULTS
We identified 814 articles, of which 94 fulfilled inclusion criteria, and 23 had sufficient data for meta-analysis. The odds ratio (OR) for clinically significant anxiety among individuals with LUTS was 2.87 (95% CI: 2.38,3.46, p < .001). The OR for LUTS among individuals with clinically significant anxiety was 2.87 (95% CI: 1.07,7.74, p < .001), although very few studies examined this relationship. A large value of I2 index suggests high heterogeneity between studies.


CONCLUSION
The results demonstrate a significant association between clinically significant anxiety and LUTS in both females and males. There were limited studies on younger individuals and on individuals ascertained for clinically significant anxiety, which should motivate further study in these areas. Understanding the co-occurrence of these conditions will lead to better prevention and interventions to ameliorate the progression of the symptoms and improve the quality of life. A thorough assessment of anxiety may provide more optimal care for LUTS patients.
['Mahjani|Behrang|B|0000-0001-6087-9537', 'Koskela|Lotta Renström|LR|', 'Batuure|Anita|A|', 'Gustavsson Mahjani|Christina|C|', 'Janecka|Magdalena|M|', 'Hultman|Christina M|CM|', 'Reichenberg|Abraham|A|', 'Buxbaum|Joseph D|JD|', 'Akre|Olof|O|', 'Grice|Dorothy E|DE|']
D001007:Anxiety D001008:Anxiety Disorders D005260:Female D006801:Humans D059411:Lower Urinary Tract Symptoms D008297:Male D011788:Quality of Life D053201:Urinary Bladder, Overactive
lower urinary tract symptoms overactive bladder interstitial cystitis anxiety disorders obsessive-compulsive disorder