Global burden and temporal trends of lower urinary tract symptoms: a systematic review and meta-analysis

Background: Lower urinary tract symptoms (LUTS) are common complaint in urology practice and affecting the quality of life for patients. This article aims to perform a systematic review and meta-analysis on the global prevalence of LUTS overall, and according to different patient characteristics. Methods: We searched MEDLINE and Embase for population-based epidemiological studies reporting the prevalence of LUTS from inception to 1 Jan 2021. Studies which: (1) have enough information on sample size and prevalence; (2) investigate individuals aged 15 or above; and (3) have clear diagnostic criteria for LUTS. We extracted the following information: year of publication; name of the first author; study period; region of recruitment; race; age range; sex; severity; symptoms; and criteria. We pooled rate estimates with exact binomial and test score-based confidence intervals (CIs) using proportions with a random-effects model. Results: We included 222 studies from 36 countries involving 1,692,110 samples and 632,933 patients with LUTS. The overall prevalence of any and moderate-to-severe LUTS was 63.2% (95% CI = 58.0–68.1) and 31.3% (95% CI = 28.8–33.8), respectively. The most common symptom was storage symptoms (56.7%; 95% CI = 51.0–62.4), followed by voiding symptoms (36.4%; 95% CI = 27.8–45.4) and post-micturition symptoms (30.7%; 95% CI = 19.2–43.6). A higher prevalence of moderate-to-severe LUTS was observed in male subjects (35.2%; 95% CI = 32.1–38.5) and individuals aged ≥60 (39.0%; 95% CI = 33.4–44.8; I² = 99.9%). Its prevalence increased from 27.4% (95% CI = 24.5–30.3) in 1990–1999, to 31.9% (95% CI = 27.3–36.7) in 2000–2009 and 36.2% (95% CI = 30.7–41.9) in 2010–2019. Conclusions: This study was the first comprehensive meta-analysis examining the global prevalence of LUTS. We identified a high level of LUTS prevalence in the general population, with a higher burden in male subjects, older individuals, and the Asian population. There has been an increasing trend in the prevalence of LUTS since the 1990s.