While metabolic syndrome (MetS) is linked to LUTS, most studies focus on men. Whether this association differs by sex remains unclear due to limited female data. We aimed to compare the association between MetS and LUTS in men versus women using sex-stratified meta-analyses.

Systematic review and meta-analysis (PRISMA-compliant, PROSPERO CRD420251181500) of cross-sectional studies. Searches were conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane up to 2024. Studies reporting IPSS or LUTS prevalence by sex were included. JBI quality assessment and random-effects meta-analyses were performed separately for male and female cohorts.

Of 80 studies in qualitative synthesis, 68 were conducted in men, 6 in women, and 5 in both sexes. For IPSS, 30 male-only cohorts showed a positive but non-significant association (SMD = 0.16, 95% CI: -0.06 to 0.39, p = 0.16). In contrast, the single female study reported a significant association (SMD = 0.35, 95% CI: 0.02 to 0.68, p = 0.04). For LUTS prevalence (OR analysis), women demonstrated a strong, significant association (OR = 1.70, 95% CI: 1.00 to 2.89, p = 0.05), while men did not (OR = 0.96, 95% CI: 0.70 to 1.32). The limited number of female studies (n=6 of 80) severely restricts generalizability.

This sex-stratified meta-analysis suggests a potentially stronger association between metabolic syndrome (MetS) and LUTS in women compared to men. While male cohorts demonstrated only a weak and non-significant relationship, female data—although limited—indicated a significant association both in symptom severity and LUTS prevalence. These findings may reflect underlying sex-specific mechanisms, including hormonal changes (e.g., postmenopausal estrogen decline), differences in fat distribution, and metabolic-inflammatory pathways that may more directly influence bladder function in women.

However, the interpretation is substantially limited by the marked imbalance in available data, with female participants being severely underrepresented. The reliance on a single study for IPSS outcomes in women further weakens the robustness of conclusions. Therefore, while the observed trend is clinically intriguing and hypothesis-generating, it cannot yet support definitive sex-specific recommendations. Future well-designed, large-scale prospective studies with adequate female representation are essential to validate these findings and clarify underlying pathophysiological differences.

The association between MetS and LUTS may be stronger in women than in men, potentially due to postmenopausal hormonal and metabolic interactions. However, female data are critically insufficient. Large-scale, sex-stratified prospective studies are urgently needed to guide sex-specific clinical recommendations.