Abstract: Background　With the aging population, lower urinary tract symptoms (LUTS) have emerged as a major global public health issue, therefore, conducting an in-depth exploration of its effective prevention and treatment strategies has become particularly urgent. Objective　To analyze the relevant factors associated with LUTS in the elderly and construct a risk assessment model. Methods　A retrospective cohort study was performed in elderly patients aged ≥60 years hospitalized at the First Medical Center of PLA General Hospital from January 2023 to January 2024. Participants were divided into LUTS group and non-LUTS group based on the presence or absence of LUTS. Given the significant gender differences in LUTS etiology and manifestations, all analyses in this study were stratified by sex. Clinical data were collected for both groups. Multivariate logistic regression was used to identify independent factors associated with elderly LUTS. Forest plots were constructed, and model performance was evaluated using receiver operating characteristic (ROC) curves, clinical calibration curves, and decision analysis curves (DCA). Results　This study included a total of 4 122 hospitalized elderly patients, comprising 2 394 males and 1 728 females. Among them, 594 cases (14.48%) had LUTS, including 438 males (18.30%) and 159 females (9.20%). Multivariate logistic regression analysis showed that age (OR=1.051, 95% CI: 1.022 - 1.084), constipation (OR=1.583, 95% CI: 1.250 - 2.002), diabetes mellitus (OR=2.591, 95% CI: 1.949 - 3.443), history of surgery (OR=2.334, 95% CI: 1.781 - 3.043), benign prostatic hyperplasia (OR=2.920, 95% CI: 2.262 - 3.781), hypertension (OR=2.771, 95% CI: 2.082 - 3.689), cerebrovascular disease (OR=2.620, 95% CI: 1.991 - 3.438), and coronary heart disease (OR=1.451, 95% CI: 1.162 - 1.823) were independent risk factors for LUTS in elderly men. Age (OR=1.030, 95% CI: 1.010 - 1.050), surgical history (OR=1.960, 95% CI: 1.490 - 2.580), diabetes (OR=3.380, 95% CI: 2.600 - 4.420), cerebrovascular disease (OR=4.810, 95% CI: 3.330 - 6.980), Parkinson's disease (OR=4.350, 95% CI: 3.240 - 5.910), hypertension (OR=3.830, 95% CI: 2.820 - 5.240), atherosclerosis (OR=4.670, 95% CI: 3.590 - 6.100), and calcium channel blockers (OR=1.820, 95% CI: 1.390 - 2.390) were independent risk factors for LUTS in elderly women. The areas under the ROC curves (AUC) were 0.856 (95% CI: 0.840 - 0.872) and 0.839 (95% CI: 0.819 - 0.860), respectively. Calibration curves demonstrated high model calibration (X2=5.689, P=0.772; X2=6.375, P=0.703), while decision curve analysis indicated clinically meaningful net benefit within specific intervals. Conclusion　The present study identifies the independent associated factors of LUTS in hospitalized elderly male and female patients, and develops gender‑stratified Logistic risk assessment models. Through multidimensional model validation, the models demonstrate good discrimination, calibration, and clinical net benefit, and provide a reliable quantitative reference for early screening, individualized prevention, and clinical decision‑making regarding LUTS in hospitalized elderly patients.