Objective <p>To assess postoperative pain levels in patients undergoing urological surgeries and identify factors associated with increased pain.</p> Patients and methods <p>This prospective single-center study (May 2022–December 2024) included 200 patients who completed the Hospital Anxiety and Depression Scale (HADS) questionnaire preoperatively. Postoperatively, the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. Predictors of heightened postoperative pain were analyzed using multivariable logistic regression.</p> Results <p>All 200 eligible patients participated. The median age was 55 years for males and 52 years for females, with males comprising 70% of participants. Most patients were married (67%) and had at least 12 years of education (89%). A history of anxiety or depression was reported in 16.5% of patients, while 65.5% had prior surgeries. The median preoperative HADS scores were 8 for males and 7 for females (<i>p</i> = 0.1), with abnormal anxiety in 40% of males and 30% of females. Increased HADS scores were significantly associated with higher postoperative pain (B = 0.165, 95% CI: 0.013–0.124, <i>p</i> = 0.016). Being unmarried was also linked to greater postoperative pain (B=-0.175, 95% CI: -1.215– (-0.091), <i>p</i> = 0.023). Other demographic and clinical factors, including age, gender, BMI, education, Charlson comorbidity score, and prior surgeries, were not significant predictors.</p> Conclusions <p>Preoperative anxiety is a strong predictor of postoperative pain in urological surgeries, highlighting the need for targeted anxiety management. Marital status also plays a role, while other demographic and clinical variables show limited predictive value.</p>