Lower urinary tract symptoms (LUTS) are a common morbidity in aging male populations. It can be a result of chronic bladder outlet obstruction and possibly chronic bladder ischemia from various etiologies. As a sign of atherosclerosis, coronary artery disease is closely associated with pelvic ischemia, which can lead to LUTS. Older male patients with more severe coronary artery disease may have more severe LUTS, possibly from a combination of a likelihood of bladder blockage. The relationship between the Gensini score and the International Prostate Symptom Score (IPSS), as well as the prevalence of LUTS in Thai male patients with coronary artery disease, were investigated to test this hypothesis.

This was a retrospective, cross-sectional study conducted at a large tertiary referral center. A cohort of 346 male patients who had coronary angiography between 2023 and 2025 was examined. LUTS severity was assessed using a validated Thai version of the IPSS, where moderate-to-severe symptoms were defined as an IPSS ≥ 8. Inclusion criteria focused on male patients with confirmed CAD; those with a history of neurogenic bladder, prior pelvic surgery, or use of medications affecting urinary function were excluded. The severity of coronary artery disease was quantified using the Gensini scoring system based on objective angiographic findings. Subgroup analyses were performed to differentiate between voiding (obstructive) and storage (irritative) symptoms. Statistical analysis utilized univariable and multivariable logistic regression to identify factors independently associated with moderate-to-severe LUTS.

The prevalence of moderate-to-severe LUTS among males with evident coronary artery disease was 30.1% (104 in 346 patients). Patients in the moderate-to-severe symptom group were significantly older than those in the mild symptom group (68.0 ± 9.8 vs. 64.5 ± 10.5 years; p = 0.005). Additionally, patients with higher International Prostate Symptom Score (IPSS) scores demonstrated significantly greater coronary artery burden as measured by the Gensini score (p = 0.017). Multivariable analysis revealed that age > 70 years (adjusted OR 1.690; p = 0.036) and a Gensini score > 50 (adjusted OR 1.791; p = 0.015) were independent predictors of moderate-to-severe LUTS. Crucially, subgroup analysis showed that a high Gensini score (> 50) was significantly associated with voiding symptoms (p = 0.016) but did not reach statistical significance for storage symptoms (p = 0.287). Other clinical factors, including BMI, PSA, prostate volume, and other chronic diseases, showed no significant association with LUTS severity.

Greater CAD burden, as measured by the Gensini score, is independently associated with more severe LUTS—specifically obstructive voiding symptoms—in male patients. This pattern is consistent with the hypothesis that systemic atherosclerosis contributes to bladder ischemia, which, combined with chronic bladder outlet obstruction more prevalent in older men, may drive progression from storage to obstructive symptoms. The absence of significant differences in storage symptoms between Gensini subgroups contrasts with prior studies involving mixed-sex or female-only cohorts reporting predominant overactive bladder associations, possibly reflecting sex-specific pathophysiology.

In male CAD patients, age and increasing CAD severity are independently associated with moderate-to-severe LUTS, particularly voiding symptoms. A Gensini score > 50 and age > 70 years are independent predictors. These findings support the role of systemic atherosclerosis and bladder ischemia in LUTS pathogenesis, suggesting that patients with greater CAD burden should be evaluated for LUTS to prevent possible complications and enhance their overall quality of life.

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Continence 19S (2026) 102709
DOI: 10.1016/j.cont.2026.102709