Abstract

Even though there is a sound rationale for neuroendocrine dysregulation due to chronic stress and its contribution to urological dysfunction through the brain-bladder axis pathway, the literature is sparse and poorly designed. The current systematic review sought to provide a synthesis of the available scientific literature concerning the effects of psychological stress, including depression, anxiety, perceived stress, adverse childhood experiences, and other related disorders, on the etiology and severity of lower urinary tract symptoms (LUTS). A systematic search across five bibliographic databases was performed up until March 2026, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420261347656). A total of 20 studies (total N = 59,882 subjects) fulfilled the inclusion criteria. LUTS was the most studied urological endpoint, mentioned in all 20 studies under consideration; kidney stone formation was not used as an endpoint in any of the studies. Psychological distress, especially depression and anxiety, is consistently linked to higher LUTS severity across various populations and methodologies. A dose-response relationship was observed between chronic major depression and development of LUTS/BPH (RR, 1.59; 95% CI, 1.11-2.28); genetic propensity for depression was an independent factor for developing nocturia (OR, 1.33), and anxiety was a risk factor for mixed urinary incontinence (OR, 1.20). Yet, causality is hampered by the use of cross-sectional methodology and subjective measures. Prospective studies that include objective urodynamic markers and stress biological markers are needed. A clinical pathway combining urology and psychiatry practice and a screening program for psychological disorders among LUTS patients can be discussed.

Key words: Lower urinary tract symptoms, LUTS, psychological stress, depression, anxiety, overactive bladder, urinary incontinence, systematic review