【Abstract】Objective To explore the correlation between quality of life and lower urinary tract symptoms (LUTS) and emotional disorders in the elderly patients with benign prostatic hyperplasia (BPH). Methods We enrolled 155 elderly BPH patients admitted to Chengmai County People′ s Hospital from January 2021 to January 2023. Their quality of life, LUTS and anxiety were investigated using revised version of quality-of-life scale for benign prostatic hyperplasia (BPHQLS), international prostate symptom score (IPSS), overactive bladder symptom scale (OABSS) and self-rating anxiety scale (SAS). SPSS statistics 19.0 was used for data processing, and t test or Chi-square test was performed for inter-group comparisons according to the data type. Pearson correlation was performed to analyze the correlation between LUTS, emotional disorders and quality of life. A structural equation model was constructed using AMO 25.0 for the mediating effect of anxiety on LUTS and quality of life in the elderly BPH patients (standardized). Results The valid questionnaire recovery rate was 96.13% (149/155) with six invalid questionnaires. The elderly BPH patients averaged (97.45±12.16) points on QLS-BPH, (12.21±2.79) points on IPSS, (8.96±2.03) points on OABSS and (48.56±8.89) points on SAS, and the incidence of anxiety was 71.14% (106/149). SAS score in the elderly BPH patients was higher than that of Chinese norm [(48.56±8.79) vs (37.22±9.72) points], and the difference was statistically significant (P < 0.05). The QLS-BPH score in the mild-to-moderate IPSS group was higher than that in the severe group [(107.12±13.45) vs (86.25±12.05) points], the SAS score was lower than that in severe group [(44.14±7.96) vs (56.59±8.87) points], and the differences were statistically significant (P< 0.05). Compared with the BPH patients without anxiety, those with anxiety had lower QLS-BPH score [(92.34±12.58) vs (110.06±14.16) points], but higher scores on IPSS [(13.29±2.69) vs (9.56±2.94) points] and OABSS [(9.50±2.17) vs (7.65±2.26) points], and the differences were statistically significant (P<0.05). Pearson correlation analysis indicated that the QLS-BPH score in the elderly BPH patients was negatively correlated with IPSS score for LUTS, OABSS score and SAS score (r=-0.411, -0.395, -0.406; P<0.05). IPSS and OABSS score were positively correlated with SAS score (r=0.443,0.451; P<0.05). LUTS had a direct negative predictive effect on the quality of life (β=-0.321; P<0.05) and an indirect (negative) effect on the quality of life through anxiety (β=-0.196; P<0.05), with a total effect of -0.517. Anxiety had a direct (negative) effect on the quality of life (β=-0.269; P<0.05). After repeated sampling of data, Bootstrap method was used for mediating effect, and the 95%CI of each model did not include 0, suggesting that the mediating effect was statistically significant (P<0.05). Conclusion Effectively easing emotional disorders and taking effective measures to improve LUTS as soon as possible are of great significance in improving the quality of life in the elderly BPH patients.