Erectile Dysfunction and Lower Urinary Tract Symptoms
Erectile Dysfunction and Lower Urinary Tract Symptoms
• Despite the differences in design, many large studies using well-powered multivariate analyses consistently provide overwhelming evidence of a link between ED and LUTS.
There is a wealth of published data in support of a link between ED and LUTS; Table 1 outlines the main results from larger published studies although it is not intended as a comprehensive list. Several reviews have also published tabulations of selected epidemiological studies that support the existence of a link between ED and LUTS that is independent of age or co-morbidities.
In some of the larger studies that have evaluated relative risk or odds ratios of the probability of a link, the results clearly highlight the association between the two conditions. For example, in the large multinational survey of the ageing male (MSAM-7), multivariate analysis showed that severity of LUTS was a strong predictor of sexual dysfunction, with an odds ratio for erection problems of 8.90 (95% CI: 6.85–11.55) in those with severe LUTS. Indeed, results from this important study essentially showed that going from mild to moderate, or moderate to severe LUTS, had a greater impact on ED than ageing by 10 years (Figure 1). Similarly, in a study involving patients in UK general practices, odds ratios for ED in patients with both storage and voidance LUTS were calculated to be 4.0 (95% CI: 3.4–4.8). From the ED perspective, a study in Finland involving over a 1000 men calculated the relative risk of LUTS in patients with severe ED as 2.3 (95% CI: 1.4–3.8). In addition to these individual studies, a recent systematic review of available epidemiological data has concluded that most men seeking treatment for either LUTS or ED have both conditions. Taken together, these results provide overwhelming evidence of the independent association between LUTS and ED and highlight the importance of awareness of this link for the practising physician.
(Enlarge Image)
Figure 1.
Erectile dysfunction according to age and lower urinary tract symptoms severity
(Enlarge Image)
Figure 2.
Potential pathophysiological pathways leading to lower urinary tract symptoms in men (Adapted from Refs )
• Current preclinical evidence suggests that several common pathogenetic mechanisms are involved in the development of both ED and LUTS associated with BPH.
The pathogenetic mechanisms underlying the relationship between LUTS and ED have been the subject of several recent reviews. These publications present preclinical data and well-defined theories for mechanisms currently thought to be involved, including, alteration of the nitric oxide-cyclic guanosine monophosphate pathway; enhancement of RhoA–Rho-kinase (ROCK) signalling; autonomic hyperactivity; and pelvic atherosclerosis. Additional contributing factors such as chronic inflammation and sex steroid ratio imbalance may also play a role. Knowledge of the common pathways linking these mechanisms should allow a better understanding of the pathophysiology of both conditions.
Evidence in Support of a Link Between ED and LUTS
Epidemiological Evidence
• Despite the differences in design, many large studies using well-powered multivariate analyses consistently provide overwhelming evidence of a link between ED and LUTS.
There is a wealth of published data in support of a link between ED and LUTS; Table 1 outlines the main results from larger published studies although it is not intended as a comprehensive list. Several reviews have also published tabulations of selected epidemiological studies that support the existence of a link between ED and LUTS that is independent of age or co-morbidities.
In some of the larger studies that have evaluated relative risk or odds ratios of the probability of a link, the results clearly highlight the association between the two conditions. For example, in the large multinational survey of the ageing male (MSAM-7), multivariate analysis showed that severity of LUTS was a strong predictor of sexual dysfunction, with an odds ratio for erection problems of 8.90 (95% CI: 6.85–11.55) in those with severe LUTS. Indeed, results from this important study essentially showed that going from mild to moderate, or moderate to severe LUTS, had a greater impact on ED than ageing by 10 years (Figure 1). Similarly, in a study involving patients in UK general practices, odds ratios for ED in patients with both storage and voidance LUTS were calculated to be 4.0 (95% CI: 3.4–4.8). From the ED perspective, a study in Finland involving over a 1000 men calculated the relative risk of LUTS in patients with severe ED as 2.3 (95% CI: 1.4–3.8). In addition to these individual studies, a recent systematic review of available epidemiological data has concluded that most men seeking treatment for either LUTS or ED have both conditions. Taken together, these results provide overwhelming evidence of the independent association between LUTS and ED and highlight the importance of awareness of this link for the practising physician.
(Enlarge Image)
Figure 1.
Erectile dysfunction according to age and lower urinary tract symptoms severity
Pathogenesis (Figure 2)
(Enlarge Image)
Figure 2.
Potential pathophysiological pathways leading to lower urinary tract symptoms in men (Adapted from Refs )
• Current preclinical evidence suggests that several common pathogenetic mechanisms are involved in the development of both ED and LUTS associated with BPH.
The pathogenetic mechanisms underlying the relationship between LUTS and ED have been the subject of several recent reviews. These publications present preclinical data and well-defined theories for mechanisms currently thought to be involved, including, alteration of the nitric oxide-cyclic guanosine monophosphate pathway; enhancement of RhoA–Rho-kinase (ROCK) signalling; autonomic hyperactivity; and pelvic atherosclerosis. Additional contributing factors such as chronic inflammation and sex steroid ratio imbalance may also play a role. Knowledge of the common pathways linking these mechanisms should allow a better understanding of the pathophysiology of both conditions.
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