The association between lower urinary tract symptoms and anxiety/depression has been shown in the literature. The study was aimed to determine whether there is a correlation between LUTS symptom scores and hospital anxiety and depression scale (HADS) in patients with LUTS.

The patients, who applied to the functional urology outpatient clinic due to LUTS between March 2021 and June 2021 and filled out required questionnaires, were included. All patients underwent UF and peak flow rate (Qmax, ml/sec), and average flow rate (Qavg, ml/sec) were recorded. The International Prostate Symptom Score (IPSS), the Visual Prostate Symptom Score (VPSS) were used in men, and the International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) in women. Depression and anxiety conditions of the patients were evaluated with HADS in all patients. The parameters of UF and all scores were compared.

A total of 70 patients (min: 30, max:70 years) were included in the study. The median age of the patients was 51 years (IQR 41-62), 39 (57%) were male, and 31 (43%) were female. Qmax was 15 ml/sec (IQR 11-26), Qavg 11 ml/sec (IQR 7-14), median voided volume 335 ml (IQR 177-456). IPPS was found to be 16 (IQR 11-23), VPSS 13 (IQR 10-16) in males, and ICIQ-FLUTS 78 (IQR 38-100) in females. The median depression score of the patients was 7 (IQR 5-10) and the anxiety score was 8 (IQR 5-12).
There was a negative correlation between Qmax, Qavg, and IPSS, VPSS in males (p<0.01) (Table 1). Also, a positive correlation was found between IPSS and HADS anxiety (p:0.002), HAD depression (p=0.016); and between VPSS and HADS anxiety (p:0.018), HAD depression (p=0.028). Similarly, there was a positive correlation between ICIQ-FLUTS and HADS depression (p=0.033) in females, however, the correlation was absent between ICIQ-FLUTS and HADS anxiety (p=0.058) (Table 2). Qmax and Qavg were found not to be associated with HADS in females (p=0.08, p=0.07, p=0.07, p=0.09, respectively).

There are many studies in the literature comparing VPSS and IPSS in the evaluation of LUTS in men. In a prospective study, Ceylan et al reported a positive correlation between total IPSS and total VPSS in men with LUTS (r = 0.72; p <.001) [1]. Similarly in our study, we were found a positive correlation between IPSS and VPSS values (p=0.034).
Although the relationship between anxiety, depression, and LUTS has received increasing attention recently, the nature of the causal relationship between them is still unclear. Huang et al. discovered that the incidence of anxiety/depression was higher in the LUTS group than in the non-LUTS group with a hazard ratio of 2.12 and 2.03, respectively [2]. Similar to our study, anxiety, and depression scores were found to be correlated with LUTS symptom scores.

The study shows that patients with LUTS suffer from anxiety and depression. We consider that these conditions should be taken into account in the management of LUTS. Prospective studies with large case series are needed for clearer inferences.

Yasin Ceylan, Bulent Gunlusoy, Tansu Degirmenci, Zafer Kozacioglu, Deniz Bolat, Suleyman Minareci: Is new Visual Prostate Symptom Score useful as International Prostate Symptom Score in the evaluation of men with lower urinary tract symptoms? A prospective comparison of 2 symptom scores in Turkish society, Urology (2015) Mar; 85(3): 653-7. doi: 10.1016/j.urology.2014.10.057
Charles Lung-Cheng Huang, Ming-Ping Wu, Chung-Han Ho, Jhi-Joung Wang: The bidirectional relationship between anxiety, depression, and lower urinary track symptoms: A nationwide population-based cohort study, Journal of Psychosomatic Research (2017), doi: 10.1016/j.jpsychores.2017.07.008