Lower Urinary Tract Symptoms and Erectile Dysfunction
Lower Urinary Tract Symptoms and Erectile Dysfunction
Objective: Assess and categorise the available prevalence data on coexistent LUTS and ED in the general population and among individuals consulting a healthcare provider for any reason or when seeking treatment for LUTS and/or ED.
Methods: Literature search of English-language articles published during the last 15 years.
Results: Of 23 relevant studies identified, 12 used both the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) as assessment tools and 11 used alternative approaches. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS/ED of any severity was not assessable for men in the general population, but rates ranged from 14–37% based on alternative assessments. In the general male population, 13–29% had moderate to severe LUTS and 8–35% had moderate to severe ED. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS and ED of any severity was 71–80% among men seeking treatment for LUTS, and 74% based on alternative assessments. Among men who sought treatment for either condition, 67–100% had moderate to severe LUTS and 43–59% had moderate to severe ED. Coexistence of LUTS and ED increased with age, ranging from 59–86% among men aged 40s to 60s in primary care to 79–100% in treatment-seeking men with LUTS aged 50s to 70s. Impact on QoL varied, but health-related QoL was generally worse in treatment-seeking men compared with men in the general population.
Conclusions: Although less than one-third of middle-aged and older men in the general population have coexisting LUTS and ED, most men seeking treatment for either LUTS or ED have both conditions. Symptom severity and impact on QoL in each condition increase when LUTS and ED coexist.
Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) often coexist with erectile dysfunction (ED) in the ageing man. While the two conditions may be linked from an epidemiological perspective, their shared pathophysiological association is under debate.
Although prostate enlargement because of the histological diagnosis of BPH has long been associated with LUTS, it is widely recognised not to be the exclusive cause as some men with LUTS may not have BPH, and some men with BPH may not have LUTS. LUTS are typically categorised into one of three domains: voiding, storage and postmicturition symptoms, and are often assessed using the validated International Prostate Symptom Score (IPSS) questionnaire. ED, defined as the consistent change in the quality of erection adversely affecting subject satisfaction with sexual intercourse, may be assessed as a yes/no to a single question, or more in-depth using the validated International Index of Erectile Function (IIEF) questionnaire.
Epidemiological data are often used to better understand the impact of a disorder on the patient and the potential burden to society. Although a treatment-seeking patient typically has more severe symptoms than an individual from the general population, a high prevalence rate of one or more disorders does not necessarily translate into high demand for medical treatment. Although some men are sufficiently bothered to seek treatment, others may see their condition(s) as natural signs of ageing and may cope well with watchful waiting. One reason men may not seek treatment for LUTS is because it may be a fluctuating condition with progression and remission. Men with ED and/or LUTS also may not seek treatment because they are embarrassed to discuss their condition with their physician, because they perceive their condition as a natural sign of ageing, because they have no sexual partner or because they are concerned about the cost of treatment.
As available epidemiological studies in men with LUTS and/or ED vary with regard to how these disorders are defined, target populations and study design, evaluation of the coexistence of these conditions should be done carefully.
A graded assessment seems necessary to provide clinicians and healthcare systems with a reasonable and balanced estimate of the prevalence of coexisting LUTS and ED and the burden these conditions impose on patients, healthcare plans and society. Our expectation for each of these conditions was that the prevalence, severity and impact on quality of life (QoL) would increase from men in the general population to those seeking treatment, and that the coexistence of both conditions would further impact the individual.
The aim of this study was therefore to examine the peer-reviewed, indexed, global epidemiological data on prevalence of coexisting LUTS and ED in the general population and in a variety of treatment settings, and to categorise these data based on the use of validated questionnaires or simple questions, as well as to identify the impact of age and reported severity of these conditions, and degree of bother associated with coexisting LUTS and ED.
Abstract and Introduction
Abstract
Objective: Assess and categorise the available prevalence data on coexistent LUTS and ED in the general population and among individuals consulting a healthcare provider for any reason or when seeking treatment for LUTS and/or ED.
Methods: Literature search of English-language articles published during the last 15 years.
Results: Of 23 relevant studies identified, 12 used both the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) as assessment tools and 11 used alternative approaches. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS/ED of any severity was not assessable for men in the general population, but rates ranged from 14–37% based on alternative assessments. In the general male population, 13–29% had moderate to severe LUTS and 8–35% had moderate to severe ED. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS and ED of any severity was 71–80% among men seeking treatment for LUTS, and 74% based on alternative assessments. Among men who sought treatment for either condition, 67–100% had moderate to severe LUTS and 43–59% had moderate to severe ED. Coexistence of LUTS and ED increased with age, ranging from 59–86% among men aged 40s to 60s in primary care to 79–100% in treatment-seeking men with LUTS aged 50s to 70s. Impact on QoL varied, but health-related QoL was generally worse in treatment-seeking men compared with men in the general population.
Conclusions: Although less than one-third of middle-aged and older men in the general population have coexisting LUTS and ED, most men seeking treatment for either LUTS or ED have both conditions. Symptom severity and impact on QoL in each condition increase when LUTS and ED coexist.
Introduction
Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) often coexist with erectile dysfunction (ED) in the ageing man. While the two conditions may be linked from an epidemiological perspective, their shared pathophysiological association is under debate.
Although prostate enlargement because of the histological diagnosis of BPH has long been associated with LUTS, it is widely recognised not to be the exclusive cause as some men with LUTS may not have BPH, and some men with BPH may not have LUTS. LUTS are typically categorised into one of three domains: voiding, storage and postmicturition symptoms, and are often assessed using the validated International Prostate Symptom Score (IPSS) questionnaire. ED, defined as the consistent change in the quality of erection adversely affecting subject satisfaction with sexual intercourse, may be assessed as a yes/no to a single question, or more in-depth using the validated International Index of Erectile Function (IIEF) questionnaire.
Epidemiological data are often used to better understand the impact of a disorder on the patient and the potential burden to society. Although a treatment-seeking patient typically has more severe symptoms than an individual from the general population, a high prevalence rate of one or more disorders does not necessarily translate into high demand for medical treatment. Although some men are sufficiently bothered to seek treatment, others may see their condition(s) as natural signs of ageing and may cope well with watchful waiting. One reason men may not seek treatment for LUTS is because it may be a fluctuating condition with progression and remission. Men with ED and/or LUTS also may not seek treatment because they are embarrassed to discuss their condition with their physician, because they perceive their condition as a natural sign of ageing, because they have no sexual partner or because they are concerned about the cost of treatment.
As available epidemiological studies in men with LUTS and/or ED vary with regard to how these disorders are defined, target populations and study design, evaluation of the coexistence of these conditions should be done carefully.
A graded assessment seems necessary to provide clinicians and healthcare systems with a reasonable and balanced estimate of the prevalence of coexisting LUTS and ED and the burden these conditions impose on patients, healthcare plans and society. Our expectation for each of these conditions was that the prevalence, severity and impact on quality of life (QoL) would increase from men in the general population to those seeking treatment, and that the coexistence of both conditions would further impact the individual.
The aim of this study was therefore to examine the peer-reviewed, indexed, global epidemiological data on prevalence of coexisting LUTS and ED in the general population and in a variety of treatment settings, and to categorise these data based on the use of validated questionnaires or simple questions, as well as to identify the impact of age and reported severity of these conditions, and degree of bother associated with coexisting LUTS and ED.
Source...