Autonomic Nervous System and Overactive Bladder: A Systematic Review
Abstract
AIM
This systematic review aims to evaluate the relationship between autonomic nervous system (ANS) dysregulation and lower urinary tract symptoms (LUTS), particularly in overactive bladder (OAB) and LUTS associated with benign prostatic hyperplasia (LUTS-BPH), while also assessing the impact of therapeutic interventions on ANS function.
METHODS
A comprehensive literature search was conducted in PubMed, Scopus, and Embase (September 2024, final update in March 2025) following PRISMA guidelines. Studies were included if they focused on non-neurogenic OAB and explicitly assessed ANS dysfunction using heart rate variability (HRV), skin sympathetic response (SSR), pupillometry, autonomic function tests, or noradrenergic hormonal system evaluations. Two independent reviewers screened, extracted, and categorized the data into ANS dysfunction and treatment effects on ANS function.
RESULTS
Out of 1,285 screened abstracts, 29 studies were included. Thirteen studies investigated ANS dysregulation in OAB, with HRV being the most used method, revealing inconsistent patterns of sympathetic and parasympathetic imbalance. Four studies focused on LUTS-BPH, suggesting a possible role of ANS dysfunction in symptom severity. Fourteen studies examined the impact of treatments, including behavioral interventions, anticholinergics, alpha-blockers, tibial neurostimulation, and sacral neuromodulation, revealing variable effects on ANS function.
CONCLUSION
ANS dysfunction is associated with OAB and…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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