Association of Lower Urinary Tract Symptoms and Erectile Dysfunction

Abstract and Introduction

Abstract

There is strong evidence from multiple epidemological studies that lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are correlated, independent of age or comorbidities as diabetes or hypertension. Although a direct causal relationship is not established yet, four pathophysiological mechanisms can explain the relationship. These include alteration in nitric oxide bioavailability, α1-adrenergic receptor hyperactivity, pelvic atherosclerosis and sex hormones. This association has different clinical implications on the management of both disorders. Men seeking care for one condition should always be screened for complaints of the other condition. Sexual function should be assessed and discussed with the patient when choosing the appropriate management strategy for LUTS, as well as when evaluating the patient’s response to treatment. Multiple large clinical trials have shown an improvement in LUTS after phosphodiesterase-5 (PDE5)-inhibitor treatment. PDE5 inhibitors show promise as a future treatment for LUTS, either in conjunction with existing therapies or as a primary treatment. There may be a potential therapeutic role for testosterone in LUTS treatment in cases of testosterone deficiency that needs to be investigated. Much further investigation is required, but it is evident that the association between LUTS and ED is fundamental for future therapies and possible preventative strategies.

Introduction

In recent years, increasing attention has been given to the interaction and relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Both complaints are highly prevalent in the aging male and share common risk factors, such as hypertension, hypercholesterolemia and diabetes mellitus. Aside from these common denominators, an independent association has been elucidated in a number of large-scale international trials. There is a strong correlation between age and ED, with prevalence increasing steadily from 6.5% in men aged 20–39 years to 77.5% in those 75 years and older.^[1] A similar increase in the prevalence of LUTS in men has been observed from somewhat <1 in 10 in men aged 30–39 years to >1 in 3 in men aged 60–69 years.^[2] In total, as much as three in four men are likely to experience LUTS sometime during their lifespan.^[3] Both disorders have a major impact on quality of life (QoL) on individual patients, and further have a major socio-economic impact. In this review, we focus on the epidemiological and pathophysiological correlation of LUTS and ED, and discuss the impacts of this association on the clinical management of both disorders.

LUTS and ED are common disorders in aging men, which are independently associated to one another. The two disorders share certain pathophysiologic mechanisms and this association has many clinical implications. It is recommended that men presenting with LUTS should be evaluated for sexual dysfunction and ED in particular, and those presenting with sexual dysfunction should be evaluated for LUTS. Patients should further be screened for risk factors for underlying disorders. In treating LUTS, the presence or absence of sexual dysfunction may affect the choice of therapy, especially once patient preferences are considered. For this indication, the introduction of PDE-5 inhibitors is gaining acceptance. In patients with obstructive LUTS, the association of an α-blocker may be of benefit. Ongoing research is further elucidating these complex interactions, and might hold promise for future therapy of men suffering from both LUTS and ED.