Martin Sean A, Tully Phillip J, Kahokehr Arman A, Jay Alex, Wittert Gary A
Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia.
School of Psychology, University of New England, Armidale, New South Wales, Australia.
Neurourol Urodyn. 2022 Feb;41(2):552-561. doi: 10.1002/nau.24868. Epub 2022 Jan 12.
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.
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.
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 (I = 83%; τ = 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 (I = 58%; τ = 0,02; p = 0.001).
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.
观察性研究的最新证据表明，男性下尿路症状（LUTS）与抑郁症之间存在双向关联。我们试图系统地量化成年男性中，与无LUTS者相比，存在LUTS对抑郁症状的影响，反之亦然。
检索电子数据库（MEDLINE、PsycINFO、SCOPUS、Embase），查找2021年3月之前的英文文章。纳入18岁以上男性的观察性研究；报告LUTS与抑郁症之间的关联；包括LUTS和抑郁症状的有效量表的研究符合纳入标准。
1787条记录中的17项研究确定了163466名按LUTS状态报告有抑郁症状的男性，而10项研究报告了72363名按抑郁症状报告有LUTS的男性。合并估计显示，存在LUTS对抑郁风险有强烈影响（OR：2.89，95%CI：2.50 - 3.33），在所检查的研究中存在高度异质性（I² = 83%；τ² = 0.06；p < 0.001）。亚组分析表明，按研究地区（Q值：13.7，自由度：4，p = 0.003）、研究背景（7.8(2)，p = 0.020）、研究设计（7.2(1)，p = 0.003）、质量（6.2(1)，p = 0.013）和LUTS测量方法（40.9(3)，p < 0.001）存在差异。合并估计还显示，存在抑郁症对男性LUTS风险有强烈影响（OR：3.13，95%CI：2.72 - 3.60），研究之间只有中度异质性（I² = 58%；τ² = 0.02；p = 0.001）。
观察到的LUTS与抑郁症之间的密切关系意味着存在共同的风险因素，不能仅归因于前列腺。这对未来的研究以及这两种疾病患者的评估和管理具有直接意义。
