Relationships between lower urinary tract symptoms, the bother they induce and erectile dysfunction

Abstract

To study the relationships between lower urinary tract symptoms (LUTS), LUTS-induced bother, age and erectile dysfunction. A survey consisting of two questionnaires, the International Prostate Symptom Score (IPSS) (reflecting LUTS) and the International Index of Erectile Function (IIEF)-5 (reflecting erectile function), together with instructions on how to perform timed micturition, was sent to 2000 randomly selected men (age range 60-70 years) living in the five counties surrounding our hospital. The IPSS questionnaire included a question concerning the degree of bother induced by LUTS. The survey was answered by 1096 men; after the exclusion of incomplete answers, 924 surveys were evaluated. Of these 924 men, 725 (78%) were sexually active and included in the analyses. The prevalence of moderate-to-severe LUTS (IPSS>or=8) was 45%. The prevalence of erectile dysfunction (ED), defined as an IIEF-5 score of <or=20, was 44%. IPSS correlated significantly with timed micturition, but not with age. IPSS was also, as expected, strongly correlated with LUTS-induced bother (correlation coefficient [c.c.] 0.76). The IIEF-5 score was correlated with timed micturition and age. There was a significant correlation between the IIEF-5 score and IPSS (c.c. -0.29; p<0.001). The IIEF-5 score was also correlated with LUTS-induced bother (c.c. -0.30; p<0.001). In a multivariate analysis, the presence of ED (IIEF-5 score<or=20) was significantly correlated with IPSS, LUTS-induced bother and age, but not with timed micturition. Men who were more severely bothered by LUTS more often had ED than those who were less bothered by them. LUTS and the bother it induces were independently significantly correlated with ED, as reflected by the IIEF-5 score. The relationships were, however, rather weak and we recommend further studies, preferably of a longitudinal and/or qualitative character, to gain a more profound understanding of the interaction, probably multifactorial, between LUTS, the bother it induces and ED. Such studies are necessary not only in order to better understand the possible causality but also to evaluate whether the relationships are of any practical value regarding the management of individual patients.