Lower urinary tract symptoms are elevated with depression in Japanese male

Lower urinary tract symptoms are elevated with depression in Japanese male | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lower urinary tract symptoms are elevated with depression in Japanese male Masanobu Yamazaki, Sahoko Ninomiya, Akihito Hashizume, Teppei Takeshima, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9310496/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background About half of both men and women have lower urinary tract symptoms, and aging is reported to have a significant impact on these symptoms. Lifestyle-related diseases such as diabetes, hypertension, and metabolic syndrome are said to be comorbidities of lower urinary tract symptoms in men, and there are reports that lower urinary tract symptoms also affect mental health, such as quality of life, depression, and anxiety symptoms. In this study, we report on the association between lower urinary tract symptoms and depressive symptoms in men using a web-based questionnaire. Methods Of the 4.5 million people registered as monitors with the Internet research company (Freeasy I-Bridge), 4,000 Japanese males without a history of smoking were selected as subjects for a questionnaire (Overactive Bladder Symptom Score; OABSS; International Consultation on Incontinence Questionnaire-Short Form; ICIQ-SF; International Prostate Symptom Score; IPSS; Quality Of Life index; IPSS International Consultation on Incontinence Questionnaire-Short Form; ICIQ-SF; International Prostate Symptom Score; IPSS; Quality Of Life index; QOL index) and depression status (OABSS, IPSS, IPSS, QOL index). All patients who responded to all items during the 2-week request period were included in the analysis, and t-tests, χ Square test, and One factor ANOVA tests were performed for urinary symptoms and depressive symptoms. Results A survey was conducted on 4,000 Japanese men, with 2,658 responses received, and the average age was 46.4 years. The average age decreased in correlation with the severity of QIDS-J (p<0.001). No significant difference was observed in OABSS scores based on QIDS-J severity (p=0.245), but both ICIQ-SF and IPSS scores were significantly higher as QIDS-J severity increased (both p<0.001). The OAB diagnosis rate showed a significant difference according to the severity of QIDS-J (p=0.008), but the UUI diagnosis rate did not show a significant difference according to the severity of QIDS-J (p=0.500). Additionally, a separate analysis was conducted for the 20–40 age group, and while OABSS did not show a significant difference based on QIDS-J severity (p=0.7358), ICIQ-SF and IPSS did show a significant difference based on QIDS-J severity (both p<0.001). The OAB diagnosis rate and UUI diagnosis rate both showed no significant difference based on the severity of QIDS-J (p=0.708 and p=0.621, respectively). Conclusions The ICIQ-SF and IPSS tended to be higher with more depressive symptoms for both all ages and ages 20-40, but no association with OABSS was found. Lower Urinary Tract Syndrome Depression Japanese Men Questionnaire Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Lower urinary tract symptoms (LUTS) included overactive bladder (OAB), benign prostate hyperplasia (BPH), and bladder outlet obstruction (BOO). The EpiLUTS study showed LUTS around 47% in male and 46% in female [1]. Other previous studies revealed that LUTS were detected around 20–50% in both gender [2–4]. The prevalence of LUTS are increased by age. And diabetes mellitus, hypertension, and cardiovascular disease also affected LUTS [5–10]. In male, the prevalence of BPH is 40% in 50–59 years old and 70% in 60–69 years old male [11]. Thus, the prevalence of LUTS were higher in old male than females. In male, LUTS has been reported to be influenced by metabolic syndrome including obesity, diabetes mellitus, dyslipidemia, and hypertension [12, 13]. EPIC study revealed that OAB lowers quality of life (QOL) [14–16]. OAB not only lowers QOL but also affects depression, anxiety, and disorder [16–18]. Incontinence and BPH have also been reported correlated with depression [19–22]. Some studies showed that higher international prostate symptom score (IPSS) lowered QOL [21–26]. Few studies have not been reported between LUTS and depression in Asian Japanese male in each generation. The present study examined the correlation between LUTS and depression status in each generation. MATERIALS & METHODS Of those registered as monitors at an Internet research company (Freeasy/I-Bridge), 4,000 Japanese males with no smoking history who agreed to “cooperate with the Internet survey, follow the handling of personal information, and use the information as aggregate data” on the response screen of this survey were targeted. Four thousand subjects were included in the study. The study period was from the start of the questionnaire to July 30, 2020, two weeks after the start of the survey. The study was approved by the Investigational Review Board (IRB) of Yokohama City University Medical Center (approval number: B201000053). Informed consent to participate in the study were was obtained before answering questionnaire. Experimental procedures were conducted in accordance with the ethical standards of the Helsinki Declaration. Questionnaires (Overactive Bladder Symptom Score; OABSS, International Consultation on Incontinence Questionnaire-Short Form; ICIQ-SF, International Prostate Symptom Score; IPSS, Quality of Life index; QOL index) and depression status (Quick Inventory of Depressive Symptomatology; QIDS-J) and information provided by Freeasy Inc. regarding age, household income, living arrangements, occupation, marital status, and presence of children. The OABSS is a questionnaire consisting of four items: daytime frequency, nighttime frequency, urgency, and urge urinary incontinence. A total score of 3 points or higher and a score of 2 points or higher on Q3 were defined as overactive bladder. Urge urinary incontinence (UUI) was defined as a score of 2 points or higher on Q4. Daytime urinary frequency is defined as Q1 scoring 1 point or higher, and nocturnal urinary frequency is defined as Q2 scoring 2 points or higher. The ICIQ-SF is a questionnaire consisting of three items: frequency of urinary incontinence, volume of urinary incontinence, and impact on daily life. A higher total score indicates a more severe condition. UUI in the ICIQ-SF is defined by Q4-2, while stress urinary incontinence (SUI) is defined by at least one of Q4-3 or Q4-5. Mixed urinary incontinence (MUI) is defined when both UUI and SUI criteria are met in the ICIQ-SF. Post-micturition dribble (PMD) is defined by Q4-6. The IPSS is a questionnaire consisting of seven items related to symptoms experienced in the past month. In this study, urinary symptoms were evaluated using the IPSS score and QOL score. Nocturia is defined as a score of 1 or higher on Q7. The IPSS voiding score (IPSS-V; IPSS voiding subscore) is defined as the sum of Q1, 3, 5, and 6, and the IPSS storage score (IPSS-S; IPSS storage subscore) is defined as the sum of Q2, 4, and 7. An IPSS score of 8 or higher is defined as moderate severity, and 20 or higher as severe. The QIDS-J is a questionnaire consisting of 16 items: 4 items related to sleep, 4 items related to appetite and weight, 2 items related to psychomotor state, and 6 other items. The severity of depression can be evaluated by the total score of 9 items, including sleep, appetite and weight, psychomotor state, and the other 6 items. Statistical analysis The participants’ characteristics and scores were analyzed by the Mann-Whitney U and one-factor analysis of variance (ANOVA) tests, and the prevalence of daytime frequency, nocturia, urgency, UUI, SUI, MUI, and PMD was analyzed by a chi-square test using the Graph Pad Prism software program (Graph Pad Software, La Jolla, CA, USA). P values of < 0.05 were considered to indicate statistical significance RESULTS A questionnaire was sent to 4000 Japanese men with no smoking history, and 2658 responded (49%). Patient background is shown in Table 1. The mean age was 46.4 ± 15.9 years. Of the 2658 patients, 1232 (46%) were married men and 1008 (38%) had children. Figure 1 shows the mean age of each of the three categories of QIDS-J: normal, mild, moderate, severe, and very severe (P < 0.0001). The mean age tended to get younger as the severity of the QIDS-J increased. Figure 2 shows the mean values of OABSscore, ICIQ-SFscore, and IPSscore for all age males by QIDS-J severity, with no significant difference in OABSS (P = 0.2541), but significant differences in ICIQ-SFscore and IPSS (P < 0.0001). The mean ICIQ-SFscore for adult males with normal QIDS-J scores was 0.80, mild 1.45, moderate 2.05, severe 3.01, and very severe 3.60. IPSS scores of 0–7 are classified as mild, 8–19 as moderate, and 20–35 as severe; the mean IPSS score for adult males with normal QIDS-J was 3.11 (IPSS mild), 5.13 (IPSS mild), 5.69 (IPSS moderate), and 7.50 (IPSS severe), The most severe was 8.59 (IPSS moderate). OABSS, where mild is defined as a score of 5 or less, moderate as a score of 6–11, and severe as a score of 12 or more; the mean OABSS score for adult males with a normal QIDS-J classification was 0.15 (OABSS mild), mild was also 0.15 (OABSS mild), moderate was 0.17 (OABSS mild), severe was 0.20 (OABSS mild), and 0.19 (OABSS very severe), with no significant differences when compared by severity of QIDS-J. Figure 3 shows the percentage of men of all ages diagnosed with OAB and UUI according to QIDS-J severity. Among men diagnosed with OAB, 14.8% were classified as normal, 13.6% as mild, 20.5% as moderate, 21.5% as severe, and 22.1% as very severe (P = 0.008) For UUI, 14.9% of adult men classified as normal on the QIDS-J were diagnosed with UUI, 14.8% were mild, 16.7% were moderate, 19.6% were severe, and 19.6% were very severe (P = 0.460). Next, we focused on men aged 20 to 40 and presented the average values of OABSScore, ICIQ-SFscore, and IPSscore by QIDS-J severity in Fig. 4. Similar to the results for all men, there was no significant difference in OABSS (P = 0.736), but there was a significant difference in ICIQ-SFscore and IPSS (P < 0.001). The average ICIQ-SF score for men aged 20–40 classified as normal on the QIDS-J was 0.50, mild was 1.20, moderate was 2.02, severe was 3.41, and very severe was 4.32. The mean IPSS scores for men aged 20–40 years who were classified as normal by QIDS-J were 1.60 (mild IPSS), 3.59 (mild IPSS) for mild, 4.83 (mild IPSS) for moderate, 8.14 (moderate IPSS) for severe, and 8.91 (moderate IPSS) for very severe. The results showed that ICIQ-SF was severe or above, and IPSS was moderate or above. Figure 5 shows the percentage of men aged 20–40 diagnosed with OAB and UUI according to QIDS-J severity. Among men aged 20–40 years, 19.6% of those classified as normal on the QIDS-J were diagnosed with OAB, 17.6% were classified as mild, 21.0% as moderate, 24.5% as severe, and 20.8% as very severe (P = 0.708). Among men aged 20–40 years with normal QIDS-J scores, 17.1% were diagnosed with UUI, 18.1% with mild severity, 18.1% with moderate severity, 23.5% with severe severity, and 15.1% with very severe severity (P = 0.621). DISCUSSION Although there have been long-term studies evaluating the relationship between lower urinary tract symptoms and depression in healthy men using the IPSS [27], we investigated lower urinary tract symptoms in healthy men using multiple items including the IPSS, ICIQ-SF, and OABSS. Although there have been studies that have focused on middle-aged and older adults [28], our study is the first to also address the association between depression and LUTS limited to young adults (20–40 years old), since we obtained results from a wide range of ages, from 20s on up. As shown in Fig. 2, although no significant difference was observed for OABSS (P = 0.2541), significant differences were observed for ICIQ-SF score and IPSS (P < 0.0001). Litman et al. reported that depressive symptoms significantly worsen LUTS symptoms and suggested that gender and race are not related factors [7]. However, the details of LUTS symptoms were not described, and the differences between urinary symptoms and storage symptoms remained unclear. Lai et al. focused on OAB (storage dysfunction) and investigated its association with anxiety symptoms, arguing that OAB is strongly associated with severe anxiety symptoms. They also noted that when anxiety symptoms coexist with OAB, storage dysfunction and incontinence symptoms worsen, significantly impairing quality of life. They also argued that this leads to depressive symptoms. Furthermore, there was no gender difference in this regard [18]. In this study, no association was found between OAB and depressive symptoms; however, since only 407 adult men (16% of adult men) reported OAB, evaluation was considered difficult. Regarding Fig. 3, there was no significant difference between OAB and UUI. This was also considered to be due to the small number of OAB-positive individuals, and UUI is one of the symptoms included in OAB. Regarding Fig. 4 and Fig. 5, the association between QIDS-J and OABSS, QIDS-J and ICIQ-SFscore, and QIDS-J and IPSS was examined, focusing on men in their 20s to 40s. In Fig. 4, the P-value for OABSS was 0.7358, and only OABSS showed no significant difference. According to Stewart et al., significant OAB symptoms, including UUI, do not appear much until the age of 65, and appear in 8.2% of men aged 65–74 and 10.2% of men aged 75 and older [16]. Therefore, while the number of men reporting OAB symptoms is already low, it decreases further as age decreases. Thus, in Figs. 4 and 5, by narrowing the age range of men to the younger group of 20–40 years, the results showed no significant difference in OAB symptoms, including UUI. Additionally, while SEIM et al. reported that the number of men complaining of urinary disorders does not increase significantly until after the age of 60, they also reported that 54.6% of men aged 20–29 met the criteria for mild or more severe IPSS, and that this increased to 56.4% among men aged 30–39, indicating that more than half of younger men also reported some form of urinary disorder [10]. Men reporting OAB symptoms did not gather in sufficient numbers across all age groups to clearly establish an association with depressive symptoms, and no significant difference was observed. On the other hand, men meeting the criteria for mild or more severe IPSS urinary dysfunction were present in large numbers across all age groups (65% of the total), and an association with depressive symptoms was confirmed, resulting in a significant difference. On the other hand, while only 27% of adult men reported some form of incontinence, the results showed that as incontinence symptoms worsened, depressive symptoms also tended to worsen. Although the number of positive cases was not as high as in the IPSS, the fact that a significant difference was observed suggests that LUTS with incontinence is more likely to be accompanied by depressive symptoms than LUTS without incontinence. As described above, LUTS and depressive symptoms are considered to be strongly related. Our results showed no association between OAB symptoms (urinary retention) and depressive symptoms in men, but we did find an association between urinary dysfunction and incontinence symptoms and depressive symptoms. Depressive symptoms are one of the diseases that are currently on the rise. It is a disease that may lead to suicide as symptoms worsen [29, 30]). While the factors involved are diverse, the association between LUTS and depressive symptoms is not widely recognized. By disseminating such findings, it is desirable to ensure that LUTS treatment, particularly incontinence treatment, is not overlooked and is conducted among general practitioners or through active consultation with urologists. Conclusion We assessed the association between LUTS and depressive symptoms in men. The ICIQ-SF and IPSS tended to be higher with more depressive symptoms for both all ages and ages 20–40, but no association with the OABSS was found. Declarations Funding Declaration Any grants or other forms of financial support has not received for the research Availability of supporting data The raw data to create tables and figures are available as a supplementary file. Ethics approval and consent to participate: The study was approved by the Investigational Review Board (IRB) of Yokohama City University Medical Center (approval number: B201000053). Informed consent to participate in the study were was obtained before answering questionnaire. CONFLICTS OF INTEREST We declare no conflicts of interests Availability of supporting data The raw data to create tables and figures are available as a supplementary file. Author Contribution MY, SN, TK obtained the date, analyzing the data, draft the original manuscript. AH, TT, HI critical comment. KM, HU, JT supervision. All authors checked and approved the final draft, table, and figures. References Sexton CC, Coyne KS, Kopp ZS, Irwin DE, Milsom I, Aiyer LP, Tubaro A, Chapple CR, Wein AJ, Epi LT: The overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK and Sweden: EpiLUTS . BJU Int 2009, 103 Suppl 3 :12–23. 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Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T: The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010 . PLoS One 2015, 10 (2):e0116820. Blazer DG: Depression in late life: review and commentary . J Gerontol A Biol Sci Med Sci 2003, 58 (3):249–265. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files mLUTSdepTable1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9310496","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626033520,"identity":"f3e64779-dc36-4787-bbba-844c7ca092f8","order_by":0,"name":"Masanobu Yamazaki","email":"","orcid":"","institution":"Yokohama City University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Masanobu","middleName":"","lastName":"Yamazaki","suffix":""},{"id":626033526,"identity":"6900f817-514f-4d4b-8fdb-4e56b8fadc42","order_by":1,"name":"Sahoko Ninomiya","email":"","orcid":"","institution":"Yokohama City University Medical 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08:10:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9310496/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9310496/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107625596,"identity":"675a43c3-ce15-4937-8ac0-4629d7b9b174","added_by":"auto","created_at":"2026-04-23 10:26:27","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":101011,"visible":true,"origin":"","legend":"\u003cp\u003eThe mean age of each of QIDS-J: normal, mild, moderate, severe, and very severe\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/7cfb943affbf20168a37ccdb.jpg"},{"id":107625577,"identity":"d1996ad4-2c80-4796-aaca-5283be912adf","added_by":"auto","created_at":"2026-04-23 10:26:17","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":304986,"visible":true,"origin":"","legend":"\u003cp\u003eMean values of a) OABSscore, b) ICIQ-SFscore, and c) IPSscore for all age males by QIDS-J severity\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/1551d410b955b9942a13eee5.jpg"},{"id":107625551,"identity":"80821111-c595-404c-9fff-739ae83c8253","added_by":"auto","created_at":"2026-04-23 10:26:14","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":405581,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of men of all ages diagnosed with a) OAB and b) UUI according to QIDS-J severity\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/a4a962503011db651ec635b6.jpg"},{"id":107625556,"identity":"80245fef-134e-4706-b58c-c8712e555e3d","added_by":"auto","created_at":"2026-04-23 10:26:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":312358,"visible":true,"origin":"","legend":"\u003cp\u003eOn men aged 20 to 40 and presented the average values of a) OABSscore, b) ICIQ-SFscore, and c) IPSscore by QIDS-J severity\u003c/p\u003e","description":"","filename":"fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/0254cefc556049e0fd63ed48.jpg"},{"id":107625552,"identity":"eae2bca6-b9d8-4dd4-ba39-929a03b62cb2","added_by":"auto","created_at":"2026-04-23 10:26:14","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":338746,"visible":true,"origin":"","legend":"\u003cp\u003eThe percentage of men aged 20–40 diagnosed with a) OAB and b) UUI according to QIDS-J severity\u003c/p\u003e","description":"","filename":"fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/e49dc056363e34566dd6a7cc.jpg"},{"id":108829890,"identity":"984c10db-3a4d-496a-9936-9241f480ef13","added_by":"auto","created_at":"2026-05-08 19:10:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1674227,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/fe8ce7fb-4b57-4d39-a78c-cac9802fe91a.pdf"},{"id":107625553,"identity":"9836267e-95aa-4638-86fa-57df80a27332","added_by":"auto","created_at":"2026-04-23 10:26:14","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20758,"visible":true,"origin":"","legend":"","description":"","filename":"mLUTSdepTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9310496/v1/1c9cdb4c48cd7d4a2717ff57.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lower urinary tract symptoms are elevated with depression in Japanese male","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLower urinary tract symptoms (LUTS) included overactive bladder (OAB), benign prostate hyperplasia (BPH), and bladder outlet obstruction (BOO). The EpiLUTS study showed LUTS around 47% in male and 46% in female [1]. Other previous studies revealed that LUTS were detected around 20\u0026ndash;50% in both gender [2\u0026ndash;4]. The prevalence of LUTS are increased by age. And diabetes mellitus, hypertension, and cardiovascular disease also affected LUTS [5\u0026ndash;10].\u003c/p\u003e \u003cp\u003eIn male, the prevalence of BPH is 40% in 50\u0026ndash;59 years old and 70% in 60\u0026ndash;69 years old male [11]. Thus, the prevalence of LUTS were higher in old male than females. In male, LUTS has been reported to be influenced by metabolic syndrome including obesity, diabetes mellitus, dyslipidemia, and hypertension [12, 13]. EPIC study revealed that OAB lowers quality of life (QOL) [14\u0026ndash;16]. OAB not only lowers QOL but also affects depression, anxiety, and disorder [16\u0026ndash;18]. Incontinence and BPH have also been reported correlated with depression [19\u0026ndash;22]. Some studies showed that higher international prostate symptom score (IPSS) lowered QOL [21\u0026ndash;26]. Few studies have not been reported between LUTS and depression in Asian Japanese male in each generation.\u003c/p\u003e \u003cp\u003eThe present study examined the correlation between LUTS and depression status in each generation.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cp\u003eOf those registered as monitors at an Internet research company (Freeasy/I-Bridge), 4,000 Japanese males with no smoking history who agreed to \u0026ldquo;cooperate with the Internet survey, follow the handling of personal information, and use the information as aggregate data\u0026rdquo; on the response screen of this survey were targeted. Four thousand subjects were included in the study. The study period was from the start of the questionnaire to July 30, 2020, two weeks after the start of the survey. The study was approved by the Investigational Review Board (IRB) of Yokohama City University Medical Center (approval number: B201000053). Informed consent to participate in the study were was obtained before answering questionnaire. Experimental procedures were conducted in accordance with the ethical standards of the Helsinki Declaration.\u003c/p\u003e \u003cp\u003eQuestionnaires (Overactive Bladder Symptom Score; OABSS, International Consultation on Incontinence Questionnaire-Short Form; ICIQ-SF, International Prostate Symptom Score; IPSS, Quality of Life index; QOL index) and depression status (Quick Inventory of Depressive Symptomatology; QIDS-J) and information provided by Freeasy Inc. regarding age, household income, living arrangements, occupation, marital status, and presence of children.\u003c/p\u003e \u003cp\u003eThe OABSS is a questionnaire consisting of four items: daytime frequency, nighttime frequency, urgency, and urge urinary incontinence. A total score of 3 points or higher and a score of 2 points or higher on Q3 were defined as overactive bladder. Urge urinary incontinence (UUI) was defined as a score of 2 points or higher on Q4. Daytime urinary frequency is defined as Q1 scoring 1 point or higher, and nocturnal urinary frequency is defined as Q2 scoring 2 points or higher. The ICIQ-SF is a questionnaire consisting of three items: frequency of urinary incontinence, volume of urinary incontinence, and impact on daily life. A higher total score indicates a more severe condition. UUI in the ICIQ-SF is defined by Q4-2, while stress urinary incontinence (SUI) is defined by at least one of Q4-3 or Q4-5. Mixed urinary incontinence (MUI) is defined when both UUI and SUI criteria are met in the ICIQ-SF. Post-micturition dribble (PMD) is defined by Q4-6. The IPSS is a questionnaire consisting of seven items related to symptoms experienced in the past month. In this study, urinary symptoms were evaluated using the IPSS score and QOL score. Nocturia is defined as a score of 1 or higher on Q7. The IPSS voiding score (IPSS-V; IPSS voiding subscore) is defined as the sum of Q1, 3, 5, and 6, and the IPSS storage score (IPSS-S; IPSS storage subscore) is defined as the sum of Q2, 4, and 7. An IPSS score of 8 or higher is defined as moderate severity, and 20 or higher as severe. The QIDS-J is a questionnaire consisting of 16 items: 4 items related to sleep, 4 items related to appetite and weight, 2 items related to psychomotor state, and 6 other items. The severity of depression can be evaluated by the total score of 9 items, including sleep, appetite and weight, psychomotor state, and the other 6 items.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe participants\u0026rsquo; characteristics and scores were analyzed by the Mann-Whitney U and one-factor analysis of variance (ANOVA) tests, and the prevalence of daytime frequency, nocturia, urgency, UUI, SUI, MUI, and PMD was analyzed by a chi-square test using the Graph Pad Prism software program (Graph Pad Software, La Jolla, CA, USA). P values of \u0026lt;\u0026thinsp;0.05 were considered to indicate statistical significance\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA questionnaire was sent to 4000 Japanese men with no smoking history, and 2658 responded (49%). Patient background is shown in Table\u0026nbsp;1. The mean age was 46.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9 years. Of the 2658 patients, 1232 (46%) were married men and 1008 (38%) had children.\u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;1 shows the mean age of each of the three categories of QIDS-J: normal, mild, moderate, severe, and very severe (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The mean age tended to get younger as the severity of the QIDS-J increased. Figure\u0026nbsp;2 shows the mean values of OABSscore, ICIQ-SFscore, and IPSscore for all age males by QIDS-J severity, with no significant difference in OABSS (P\u0026thinsp;=\u0026thinsp;0.2541), but significant differences in ICIQ-SFscore and IPSS (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The mean ICIQ-SFscore for adult males with normal QIDS-J scores was 0.80, mild 1.45, moderate 2.05, severe 3.01, and very severe 3.60. IPSS scores of 0\u0026ndash;7 are classified as mild, 8\u0026ndash;19 as moderate, and 20\u0026ndash;35 as severe; the mean IPSS score for adult males with normal QIDS-J was 3.11 (IPSS mild), 5.13 (IPSS mild), 5.69 (IPSS moderate), and 7.50 (IPSS severe), The most severe was 8.59 (IPSS moderate). OABSS, where mild is defined as a score of 5 or less, moderate as a score of 6\u0026ndash;11, and severe as a score of 12 or more; the mean OABSS score for adult males with a normal QIDS-J classification was 0.15 (OABSS mild), mild was also 0.15 (OABSS mild), moderate was 0.17 (OABSS mild), severe was 0.20 (OABSS mild), and 0.19 (OABSS very severe), with no significant differences when compared by severity of QIDS-J.\u003c/p\u003e \u003cp\u003eFigure 3 shows the percentage of men of all ages diagnosed with OAB and UUI according to QIDS-J severity. Among men diagnosed with OAB, 14.8% were classified as normal, 13.6% as mild, 20.5% as moderate, 21.5% as severe, and 22.1% as very severe (P\u0026thinsp;=\u0026thinsp;0.008) For UUI, 14.9% of adult men classified as normal on the QIDS-J were diagnosed with UUI, 14.8% were mild, 16.7% were moderate, 19.6% were severe, and 19.6% were very severe (P\u0026thinsp;=\u0026thinsp;0.460). Next, we focused on men aged 20 to 40 and presented the average values of OABSScore, ICIQ-SFscore, and IPSscore by QIDS-J severity in Fig.\u0026nbsp;4. Similar to the results for all men, there was no significant difference in OABSS (P\u0026thinsp;=\u0026thinsp;0.736), but there was a significant difference in ICIQ-SFscore and IPSS (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The average ICIQ-SF score for men aged 20\u0026ndash;40 classified as normal on the QIDS-J was 0.50, mild was 1.20, moderate was 2.02, severe was 3.41, and very severe was 4.32. The mean IPSS scores for men aged 20\u0026ndash;40 years who were classified as normal by QIDS-J were 1.60 (mild IPSS), 3.59 (mild IPSS) for mild, 4.83 (mild IPSS) for moderate, 8.14 (moderate IPSS) for severe, and 8.91 (moderate IPSS) for very severe. The results showed that ICIQ-SF was severe or above, and IPSS was moderate or above.\u003c/p\u003e \u003cp\u003eFigure 5 shows the percentage of men aged 20\u0026ndash;40 diagnosed with OAB and UUI according to QIDS-J severity. Among men aged 20\u0026ndash;40 years, 19.6% of those classified as normal on the QIDS-J were diagnosed with OAB, 17.6% were classified as mild, 21.0% as moderate, 24.5% as severe, and 20.8% as very severe (P\u0026thinsp;=\u0026thinsp;0.708). Among men aged 20\u0026ndash;40 years with normal QIDS-J scores, 17.1% were diagnosed with UUI, 18.1% with mild severity, 18.1% with moderate severity, 23.5% with severe severity, and 15.1% with very severe severity (P\u0026thinsp;=\u0026thinsp;0.621).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAlthough there have been long-term studies evaluating the relationship between lower urinary tract symptoms and depression in healthy men using the IPSS [27], we investigated lower urinary tract symptoms in healthy men using multiple items including the IPSS, ICIQ-SF, and OABSS. Although there have been studies that have focused on middle-aged and older adults [28], our study is the first to also address the association between depression and LUTS limited to young adults (20\u0026ndash;40 years old), since we obtained results from a wide range of ages, from 20s on up.\u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;2, although no significant difference was observed for OABSS (P\u0026thinsp;=\u0026thinsp;0.2541), significant differences were observed for ICIQ-SF score and IPSS (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Litman et al. reported that depressive symptoms significantly worsen LUTS symptoms and suggested that gender and race are not related factors [7]. However, the details of LUTS symptoms were not described, and the differences between urinary symptoms and storage symptoms remained unclear. Lai et al. focused on OAB (storage dysfunction) and investigated its association with anxiety symptoms, arguing that OAB is strongly associated with severe anxiety symptoms. They also noted that when anxiety symptoms coexist with OAB, storage dysfunction and incontinence symptoms worsen, significantly impairing quality of life. They also argued that this leads to depressive symptoms. Furthermore, there was no gender difference in this regard [18]. In this study, no association was found between OAB and depressive symptoms; however, since only 407 adult men (16% of adult men) reported OAB, evaluation was considered difficult. Regarding Fig.\u0026nbsp;3, there was no significant difference between OAB and UUI. This was also considered to be due to the small number of OAB-positive individuals, and UUI is one of the symptoms included in OAB. Regarding Fig.\u0026nbsp;4 and Fig.\u0026nbsp;5, the association between QIDS-J and OABSS, QIDS-J and ICIQ-SFscore, and QIDS-J and IPSS was examined, focusing on men in their 20s to 40s. In Fig.\u0026nbsp;4, the P-value for OABSS was 0.7358, and only OABSS showed no significant difference. According to Stewart et al., significant OAB symptoms, including UUI, do not appear much until the age of 65, and appear in 8.2% of men aged 65\u0026ndash;74 and 10.2% of men aged 75 and older [16]. Therefore, while the number of men reporting OAB symptoms is already low, it decreases further as age decreases. Thus, in Figs.\u0026nbsp;4 and 5, by narrowing the age range of men to the younger group of 20\u0026ndash;40 years, the results showed no significant difference in OAB symptoms, including UUI. Additionally, while SEIM et al. reported that the number of men complaining of urinary disorders does not increase significantly until after the age of 60, they also reported that 54.6% of men aged 20\u0026ndash;29 met the criteria for mild or more severe IPSS, and that this increased to 56.4% among men aged 30\u0026ndash;39, indicating that more than half of younger men also reported some form of urinary disorder [10]. Men reporting OAB symptoms did not gather in sufficient numbers across all age groups to clearly establish an association with depressive symptoms, and no significant difference was observed. On the other hand, men meeting the criteria for mild or more severe IPSS urinary dysfunction were present in large numbers across all age groups (65% of the total), and an association with depressive symptoms was confirmed, resulting in a significant difference. On the other hand, while only 27% of adult men reported some form of incontinence, the results showed that as incontinence symptoms worsened, depressive symptoms also tended to worsen. Although the number of positive cases was not as high as in the IPSS, the fact that a significant difference was observed suggests that LUTS with incontinence is more likely to be accompanied by depressive symptoms than LUTS without incontinence.\u003c/p\u003e \u003cp\u003eAs described above, LUTS and depressive symptoms are considered to be strongly related. Our results showed no association between OAB symptoms (urinary retention) and depressive symptoms in men, but we did find an association between urinary dysfunction and incontinence symptoms and depressive symptoms. Depressive symptoms are one of the diseases that are currently on the rise. It is a disease that may lead to suicide as symptoms worsen [29, 30]). While the factors involved are diverse, the association between LUTS and depressive symptoms is not widely recognized. By disseminating such findings, it is desirable to ensure that LUTS treatment, particularly incontinence treatment, is not overlooked and is conducted among general practitioners or through active consultation with urologists.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe assessed the association between LUTS and depressive symptoms in men. The ICIQ-SF and IPSS tended to be higher with more depressive symptoms for both all ages and ages 20\u0026ndash;40, but no association with the OABSS was found.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eFunding Declaration\u003c/p\u003e\n\u003cp\u003eAny grants or other forms of financial support has not received for the research\u003c/p\u003e\n\n\u003cp\u003eAvailability of supporting data\u003c/p\u003e\n\u003cp\u003eThe raw data to create tables and figures are available as a supplementary file.\u003c/p\u003e\n\n\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Investigational Review Board (IRB) of Yokohama City University Medical Center (approval number: B201000053). Informed consent to participate in the study were was obtained before answering questionnaire.\u003c/p\u003e\n\n\u003cp\u003eCONFLICTS OF INTEREST\u003c/p\u003e\n\u003cp\u003eWe declare no conflicts of interests\u003c/p\u003e\n\n\u003cp\u003eAvailability of supporting data\u003c/p\u003e\n\u003cp\u003eThe raw data to create tables and figures are available as a supplementary file.\u003c/p\u003e\n\n\u003cp\u003eAuthor Contribution\u003c/p\u003e\n\u003cp\u003eMY, SN, TK obtained the date, analyzing the data, draft the original manuscript. AH, TT, HI critical comment. KM, HU, JT supervision. All authors checked and approved the final draft, table, and figures.\u003c/p\u003e\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSexton CC, Coyne KS, Kopp ZS, Irwin DE, Milsom I, Aiyer LP, Tubaro A, Chapple CR, Wein AJ, Epi LT: \u003cstrong\u003eThe overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK and Sweden: EpiLUTS\u003c/strong\u003e. \u003cem\u003eBJU Int \u003c/em\u003e2009, \u003cstrong\u003e103 Suppl 3\u003c/strong\u003e:12\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eKupelian V, Wei JT, O\u0026apos;Leary MP, Kusek JW, Litman HJ, Link CL, McKinlay JB, Investigators BS: \u003cstrong\u003ePrevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey\u003c/strong\u003e. \u003cem\u003eArch Intern Med \u003c/em\u003e2006, \u003cstrong\u003e166\u003c/strong\u003e(21):2381\u0026ndash;2387.\u003c/li\u003e\n\u003cli\u003eCoyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, Chapple CR, Kaplan S, Tubaro A, Aiyer LP\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eThe prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study\u003c/strong\u003e. \u003cem\u003eBJU Int \u003c/em\u003e2009, \u003cstrong\u003e104\u003c/strong\u003e(3):352\u0026ndash;360.\u003c/li\u003e\n\u003cli\u003eCoyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, Aiyer LP: \u003cstrong\u003eThe burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS\u003c/strong\u003e. \u003cem\u003eBJU Int \u003c/em\u003e2009, \u003cstrong\u003e103 Suppl 3\u003c/strong\u003e:4\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eDanforth KN, Townsend MK, Lifford K, Curhan GC, Resnick NM, Grodstein F: \u003cstrong\u003eRisk factors for urinary incontinence among middle-aged women\u003c/strong\u003e. \u003cem\u003eAm J Obstet Gynecol \u003c/em\u003e2006, \u003cstrong\u003e194\u003c/strong\u003e(2):339\u0026ndash;345.\u003c/li\u003e\n\u003cli\u003eHaidinger G, Temml C, Schatzl G, Brossner C, Roehlich M, Schmidbauer CP, Madersbacher S: \u003cstrong\u003eRisk factors for lower urinary tract symptoms in elderly men. 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quality of life in patients with LUTS suggestive of BPH\u003c/strong\u003e. \u003cem\u003eEur Urol \u003c/em\u003e2001, \u003cstrong\u003e40 Suppl 1\u003c/strong\u003e:13\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eVela-Navarrete R, Alfaro V, Badiella LL, Fernandez-Hernando N: \u003cstrong\u003eAge-stratified analysis of I-PSS and QoL values in spanish patients with symptoms potentially related to BPH\u003c/strong\u003e. \u003cem\u003eEur Urol \u003c/em\u003e2000, \u003cstrong\u003e38\u003c/strong\u003e(2):199\u0026ndash;207.\u003c/li\u003e\n\u003cli\u003eTuncay Aki F, Aygun C, Bilir N, Erkan I, Ozen H: \u003cstrong\u003ePrevalence of lower urinary tract symptoms in a community-based survey of men in Turkey\u003c/strong\u003e. \u003cem\u003eInt J Urol \u003c/em\u003e2003, \u003cstrong\u003e10\u003c/strong\u003e(7):364\u0026ndash;370.\u003c/li\u003e\n\u003cli\u003eEckhardt MD, van Venrooij GE, van Melick HH, Boon TA: \u003cstrong\u003ePrevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being\u003c/strong\u003e. \u003cem\u003eJ Urol \u003c/em\u003e2001, \u003cstrong\u003e166\u003c/strong\u003e(2):563\u0026ndash;568.\u003c/li\u003e\n\u003cli\u003eHunter DJ, Berra-Unamuno A, Martin-Gordo A: \u003cstrong\u003ePrevalence of urinary symptoms and other urological conditions in Spanish men 50 years old or older\u003c/strong\u003e. \u003cem\u003eJ Urol \u003c/em\u003e1996, \u003cstrong\u003e155\u003c/strong\u003e(6):1965\u0026ndash;1970.\u003c/li\u003e\n\u003cli\u003eJolleys JV, Donovan JL, Nanchahal K, Peters TJ, Abrams P: \u003cstrong\u003eUrinary symptoms in the community: how bothersome are they?\u003c/strong\u003e \u003cem\u003eBr J Urol \u003c/em\u003e1994, \u003cstrong\u003e74\u003c/strong\u003e(5):551\u0026ndash;555.\u003c/li\u003e\n\u003cli\u003eRhee SJ, Kim EY, Kim SW, Kim SH, Lee HJ, Yoon DH, Ahn YM: \u003cstrong\u003eLongitudinal study of the relationship between lower urinary tract symptoms and depressive symptoms\u003c/strong\u003e. \u003cem\u003eJ Psychosom Res \u003c/em\u003e2019, \u003cstrong\u003e116\u003c/strong\u003e:100\u0026ndash;105.\u003c/li\u003e\n\u003cli\u003eZhang W, Cao G, Sun Y, Wu F, Wang Q, Xu T, Hu H, Xu K: \u003cstrong\u003eDepressive symptoms in individuals diagnosed with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in middle-aged and older Chinese individuals: Results from the China Health and Retirement Longitudinal Study\u003c/strong\u003e. \u003cem\u003eJ Affect Disord \u003c/em\u003e2022, \u003cstrong\u003e296\u003c/strong\u003e:660\u0026ndash;666.\u003c/li\u003e\n\u003cli\u003eWhiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T: \u003cstrong\u003eThe global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010\u003c/strong\u003e. \u003cem\u003ePLoS One \u003c/em\u003e2015, \u003cstrong\u003e10\u003c/strong\u003e(2):e0116820.\u003c/li\u003e\n\u003cli\u003eBlazer DG: \u003cstrong\u003eDepression in late life: review and commentary\u003c/strong\u003e. \u003cem\u003eJ Gerontol A Biol Sci Med Sci \u003c/em\u003e2003, \u003cstrong\u003e58\u003c/strong\u003e(3):249\u0026ndash;265.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lower Urinary Tract Syndrome, Depression, Japanese Men, Questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-9310496/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9310496/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eAbout half of both men and women have lower urinary tract symptoms, and aging is reported to have a significant impact on these symptoms. Lifestyle-related diseases such as diabetes, hypertension, and metabolic syndrome are said to be comorbidities of lower urinary tract symptoms in men, and there are reports that lower urinary tract symptoms also affect mental health, such as quality of life, depression, and anxiety symptoms. In this study, we report on the association between lower urinary tract symptoms and depressive symptoms in men using a web-based questionnaire.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eOf the 4.5 million people registered as monitors with the Internet research company (Freeasy I-Bridge), 4,000 Japanese males without a history of smoking were selected as subjects for a questionnaire (Overactive Bladder Symptom Score; OABSS; International Consultation on Incontinence Questionnaire-Short Form; ICIQ-SF; International Prostate Symptom Score; IPSS; Quality Of Life index; IPSS International Consultation on Incontinence Questionnaire-Short Form; ICIQ-SF; International Prostate Symptom Score; IPSS; Quality Of Life index; QOL index) and depression status (OABSS, IPSS, IPSS, QOL index). All patients who responded to all items during the 2-week request period were included in the analysis, and t-tests, χ Square test, and One factor ANOVA tests were performed for urinary symptoms and depressive symptoms.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eA survey was conducted on 4,000 Japanese men, with 2,658 responses received, and the average age was 46.4 years. The average age decreased in correlation with the severity of QIDS-J (p\u0026lt;0.001). No significant difference was observed in OABSS scores based on QIDS-J severity (p=0.245), but both ICIQ-SF and IPSS scores were significantly higher as QIDS-J severity increased (both p\u0026lt;0.001). The OAB diagnosis rate showed a significant difference according to the severity of QIDS-J (p=0.008), but the UUI diagnosis rate did not show a significant difference according to the severity of QIDS-J (p=0.500).\u003c/p\u003e\n\u003cp\u003eAdditionally, a separate analysis was conducted for the 20–40 age group, and while OABSS did not show a significant difference based on QIDS-J severity (p=0.7358), ICIQ-SF and IPSS did show a significant difference based on QIDS-J severity (both p\u0026lt;0.001). The OAB diagnosis rate and UUI diagnosis rate both showed no significant difference based on the severity of QIDS-J (p=0.708 and p=0.621, respectively).\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eThe ICIQ-SF and IPSS tended to be higher with more depressive symptoms for both all ages and ages 20-40, but no association with OABSS was found.\u003c/p\u003e","manuscriptTitle":"Lower urinary tract symptoms are elevated with depression in Japanese male","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 10:26:03","doi":"10.21203/rs.3.rs-9310496/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"22c8df79-b065-4c04-9236-744b0353812e","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-08T18:58:14+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T19:09:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 10:26:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9310496","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9310496","identity":"rs-9310496","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}