Lower Urinary Tract Symptoms Dysfunction Research Articles

Correlation between Lower Urinary Tract Symptoms (LUTS) and Sexual Function in Benign Prostatic Hyperplasia: Impact of Treatment of LUTS on Sexual Function

Although many reports have shown a relationship between lower urinary tract symptoms (LUTS) and sexual function (SF), it is not known which symptom(s) among LUTS should be treated to improve SF. Thus, the aim of this study was to investigate correlations between LUTS and SF and to determine which symptom(s) should be improved to increase SF. The correlation between the severity of LUTS and erectile dysfunction (ED) was investigated, and changes in LUTS were compared and analyzed to determine which symptom(s) should be eliminated to improve SF. The correlation between LUTS and SF was investigated in 365 men (62.04 +/- 8.26) with benign prostatic hyperplasia. To measure the severity of the LUTS and ED, the International Prostate Symptom Score (IPSS), frequency of nocturia, uroflowmetry, residual urine, transrectal ultrasonography, and the International Index of Erectile Function (IIEF)-5 were performed at the first visit. After 3 months of treatment with alpha-blockers (n = 304), they were assessed again to evaluate the effectiveness of the treatment. All parameters of LUTS (IPSS, age, residual urine, uroflow rate, and nocturia) except prostate volume correlated significantly with the total and each domain of IIEF-5 (P < 0.01). After 3 months, the changed scores in the IPSS-VD domain and IPSS-quality of life (QoL) correlated significantly with the improvement in total IIEF-5 and the domains of IIEF-5 (P < 0.05). The changed rates of the mean uroflow correlated significantly with the improvement in total IIEF-5 and the EF domain (P < 0.05). Among the LUTS parameters, improvement in the IPSS-VD domain, IPSS-QoL, and mean uroflow significantly correlated with an increased score in the IIEF-5 EF domain. Thus, it is expected that the improvement of voiding symptoms and uroflow will be associated with the improvement in erectile function.

Prevalence and risk factors for bothersome lower urinary tract symptoms in women with diabetes mellitus from hospital-based diabetes clinic

There is limited data on prevalence and risk factors for bothersome lower urinary tract symptoms (LUTS) in women with diabetes mellitus (DM). This study assesses prevalence and risk factors for bothersome LUTS and voiding dysfunction in women with DM. Two hundred twenty women participated in this study. Participants completed the King's health questionnaire and the international consultation on incontinence-female lower urinary tract symptom questionnaire. Symptoms prevalence and urinary flow rate were assessed. Logistic regression models for risk factors of bothersome LUTS and voiding dysfunction were constructed. One hundred forty-eight women completed the study. Sixty-one women (41%) had bothersome LUTS. Urgency incontinence, urgency, and nocturia were the most bothersome. Fifty-six (38%) had voiding dysfunction. Neuropathy and glycosylated haemoglobin were independent risk factors for voiding dysfunction. Voiding dysfunction did not affect quality of life in women with DM. Overactive bladder symptoms are the most bothersome in diabetic women. Neuropathy and glycosylated haemoglobin are risk factors for voiding dysfunction.

Male lower urinary tract symptoms: how do symptoms guide our choice of treatment?

Lower urinary tract symptoms (LUTS) include voiding, storage, and postmicturition symptoms whereas in addition LUTS and sexual dysfunction are highly prevalent in aging men. The present article investigates how symptoms can guide our initial therapeutic approach to male LUTS and provides the recent data on the current treatment options. Recent studies suggest that not all male LUTS are associated with prostate pathology and that bladder plays a role in the development of LUTS and especially in storage symptoms. In addition to the traditional drug classes including alpha-blockers and 5alpha-reductase inhibitors, there is an increasing flow of data on the use of anticholinergics and phosphodiesterase type 5 inhibitors. Available studies provide high-level evidence on the efficacy and safety of these medical treatments. The upcoming data are beginning to shape new strategies for the initial management of male LUTS. Male LUTS have a complex nature and there is an overlap of storage and voiding symptoms. Weighing of storage versus voiding symptoms is a decisive factor for the selection of medical treatment. In addition, assessment of specific voiding and prostate parameters and the status of patient's sexual function may guide our choice.

Lower urinary tract symptoms, benign prostatic hyperplasia, and sexual dysfunction

Previously viewed as independent processes, sexual dysfunction (SD) and lower urinary tract symptoms (LUTS) frequently associate and significantly detract from overall quality of life for men. Analysis of historic and emerging literature using some of the Bradford-Hill criteria argues causality between the two disease processes, with most data focusing on the interplay between LUTS and erectile dysfunction. Understanding of the relationship between SD and LUTS is crucial given the current societal age demographics leading to an increased pool of affected patients. Additional information on risk factors for either disease could potentially improve patient screening, and many currently available treatments (medical and surgical) for SD impact LUTS and vice versa.

Comparative Efficacy Assessment of Tamsulosin vs. Tamsulosin Plus Tadalafil in the Treatment of LUTS/BPH. Pilot Study

The high incidence of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in aging men and the same pathophysiology make probable to treat both disorders with the same treatment. Numerous authors evaluated the actions of PDE5i in improving the LUTS/(benign prostate hyperplasia) BPH. To assess the efficacy and safety of tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day in patients with LUTS in a crossover design study. International Prostate Symptoms Score (IPSS), IPSS Quality of Life (IPSS-QOL), maximum flow rate (Qmax), post-void residual volume (PVR), International Index of Erectile Function-Erectile Function Domain (IIEF-EF), Global Assessment Quality (GAQ). For the statistical analysis, a Tukey-Kramer multicomparison test was used. A randomized, double-blind, crossover study was conducted from September 2007 to February 2008 in one center. Thirty men, older than 50 years old, with a history of LUTS/BPH of at least 6 months, were randomized into two groups to receive tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day for 45 days, and then switched to the other treatment mode for other 45 days. Twenty-seven patients completed the study. Improvements of IPSS score and IPSS-QOL were significant with both treatments but greater with the drug combination. Both regimens similarly improved the Qmax and decreased the PVR volume from baseline (P < 0.001) with no significant differences between tamsulosin alone vs. tamsulosin and tadalafil (P > 0.05). The IIEF improved with tamsulosin plus tadalafil (P < 0.001) but not with tamsulosin alone (P > 0.05). The GAQ showed that all patients preferred the combination scheme. Both treatments were well tolerated. CONCLUSION; Tamsulosin 0.4 mg/day plus tadalafil 20 mg/day was more effective than tamsulosin 0.4 mg/day alone to improve LUTS and erectile dysfunction and was also well tolerated. Large-scale, randomized, placebo-controlled studies are needed to further assess the long-term safety and effectiveness of these agents in treating LUTS/BPH with or without ED.

The Role of BPH, Lower Urinary Tract Symptoms, and PSA Levels on Erectile Function of Brazilian Men Who Undergo Prostate Cancer Screening

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common problems in middle-aged and older men. Recently, epidemiologic studies have shown significant associations between severity of LUTS and male sexual dysfunction. We analyzed the role of prostate enlargement, LUTS, and prostate specific antigen (PSA) levels in the erectile function of Brazilian men who underwent prostate cancer (PCa) screening. We analyzed data from 1,008 consecutive patients enrolled in a PCa screening program. Benign prostatic hyperplasia (BPH) was defined as a prostate weight greater than 30 g as defined by digital rectal examination. For statistical analysis, we used the chi-squared and analysis of variance tests. The odds ratios (OR) for correlation of ED with prostate volume LUTS and PSA were estimated using logistic regression models. The American Urological Association (AUA) symptom score for LUTS and the International Index of Erectile Function. Mean patient age was 61.2 years (45-87) and median PSA value was 1.9 ng/mL. BPH was identified in 48.5% of patients. Mild, moderate, and severe LUTS were found in 52.3%, 30.9%, and 16.8% of cases, respectively. ED was classified as absent, mild, mild to moderate, moderate, and severe in 18.6%, 23.1%, 18.6%, 15.2%, and 24.5%, respectively. While only 5.4% of the patients with no ED presented severe LUTS, this finding was observed in 27.1% of patients with severe ED (P < 0.001). Univariate logistic regression analysis demonstrated that age, prostate volume, AUA symptom score, and PSA levels were significant predictors of ED. However, when controlled for patient age, only LUTS remained as an independent predictor of ED. Controlling for patient age, LUTS are independent risk factors for the development of ED among Brazilian men who undergo PCa screening. Antunes AA, Srougi M, Dall'Oglio MF, Vicentini F, Paranhos M, and Freire GC. The role of BPH, lower urinary tract symptoms, and PSA levels on erectile function of Brazilian men who undergo prostate cancer screening.

Lower urinary tract symptoms and sexual dysfunction: a common approach

Alpha(1)-adrenergic blockers (alpha(1)-blockers) are considered the most effective monotherapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia. Phosphodiesterase type-5 (PDE-5) inhibitors are the first-line treatment for erectile dysfunction (ED). As LUTS and ED are strongly linked, co-prescription of both drug classes is likely to increase. Interaction studies have confirmed that tadalafil, a long-acting PDE-5 inhibitor, has only marginal effects on blood pressure when co-administered with the selective alpha(1)-blockers, alfuzosin or tamsulosin. alpha(1)-blockers show an incidence of ED similar to placebo; they may even have some benefit on sexual function in men with concomitant LUTS and sexual dysfunction, with the exception of tamsulosin which causes anejaculation. On the other hand, PDE-5 inhibitors have a beneficial effect on LUTS. These agents are likely to act via different mechanisms of action, providing the rationale for combining them to treat LUTS and ED. Indeed, alfuzosin and tadalafil show an additive relaxant effect on human detrusor muscle, human prostate tissue and human corpus cavernosum in vitro. A pilot study also suggests that daily intake of alfuzosin 10 mg and sildenafil 25 mg is well tolerated and may be more effective than monotherapy to improve LUTS and ED. Further research is warranted to establish the value of this combination therapy in LUTS and ED.

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: How Can We Best Characterize the Relationship Between Erectile Dysfunction and Benign Prostatic Hyperplasia?

ABSTRACT Introduction Considerable epidemiological literature exists, showing a relationship between voiding dysfunction and sexual dysfunction. However, few basic science or prospective data are available to determine the nature of the relationship between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction. Methods and Discussion A critical evaluation of the nature of the relationship between LUTS and erectile dysfunction (ED) must include a look at the nature of the data establishing the relationship, precise definitions of the disease states being evaluated, and adherence to established normative relationships. Criteria for causality will be utilized to best determine the relationship between LUTS and ED. This article will attempt to take a critical and provocative look at where we are presently in establishing a relationship between voiding dysfunction and sexual dysfunction in order to better direct research efforts through evidence-based studies. Conclusion At present, the epidemiological data do not support a causal relationship based on Hill’s criteria for causality between LUTS and ED but suggest a less rigorous association. Additional research is needed to better characterize this relationship.

Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology

There is ample evidence from many epidemiological studies that lower urinary tract symptoms (LUTS) and sexual dysfunction are strongly linked, independently of age and comorbidities such as hypertension, diabetes, dyslipidaemia and coronary heart disease. However, a causal link between both conditions is not yet established. Four pathophysiological mechanisms currently support the relationship between LUTS and erectile dysfunction (ED): (i) The nitric oxide synthase (NOS)/NO theory; there is a reduction in NOS-containing nerves in the prostate and bladder/urethra in patients with bladder outlet obstruction (BOO), and that lack of NO or loss of protein kinase G causes ED; (ii) The autonomic hyperactivity and metabolic syndrome hypothesis: benign prostatic hyperplasia (BPH) may be part of the metabolic syndrome, which includes cardiovascular diseases (e.g. hypertension, ischaemic heart disease) and diabetes mellitus, known risk factors for ED. Hypertension, obesity, and hyperinsulinaemia have all been claimed to be associated with an increased sympathetic activity. Increased sympathetic activity is involved in LUTS/BPH and may have a role in ED/sexual dysfunction, with noradrenaline and alpha1-adrenoceptors representing a common link; (iii) the Rho-kinase activation/endothelin pathway; there can be increased Rho-kinase activity, and consequently calcium sensitivity of the contractile machinery, in prostate smooth muscle in BPH, the detrusor in BOO, corpora cavernosa in ED, and in the resistance vessels in hypertension. The actions of several factors beside noradrenaline (e.g. endothelin-1, angiotensin II), possibly involved in the increased smooth muscle activity found in both LUTS/BPH and sexual dysfunction, are dependent on Rho-kinase activity. Thus increased Rho-kinase activity might represent a common link between LUTS and sexual dysfunction; (iv) Pelvic atherosclerosis; animal models mimicking pelvic ischaemia and hypercholesterolaemia show similar smooth muscle alterations of the detrusor and corpora. Pelvic ischaemia may induce the biological modifications described above and may thus represent as well a common link between LUTS and sexual dysfunction. Studies treating one condition (e.g. ED) and measuring the impact on the other (e.g. LUTS) should further contribute to support this common link.

Update on the relationship between sexual dysfunction and lower urinary tract symptoms/benign prostatic hyperplasia

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is a condition that commonly affects older men and is often associated with sexual dysfunction. Recent evidence of an association between LUTS/BPH and sexual dysfunction will be reviewed, as well as the effects of pharmacological treatment options for symptomatic LUTS/BPH on sexual function. Large-scale epidemiological studies conducted worldwide have provided strong evidence for an association between LUTS, erectile dysfunction and ejaculatory dysfunction. In multivariate analyses controlling for age, comorbidities, and lifestyle factors, LUTS have been clearly demonstrated to be an independent risk factor for erectile and ejaculatory dysfunction. Various pathophysiological mechanisms have been proposed for the association between LUTS and male sexual dysfunction. These include autonomic hyperactivity, alterations in Rho/Rho kinase pathway, endothelial (nitric oxide synthase/nitric oxide) dysfunction, pelvic ischemia, and age-related hormone imbalances. Owing to the link between LUTS/BPH and male sexual dysfunction, patients presenting with one of these conditions should be routinely screened for the other condition. In addition, because medical and surgical treatments for LUTS/BPH are commonly associated with sexual side effects, patients with LUTS/BPH should be monitored for treatment-related sexual outcomes. LUTS/BPH is an independent risk factor for sexual dysfunction in aging men. Further studies are needed to define the mechanism(s) underlying the link between LUTS/BPH and male sexual dysfunction. Additional studies of combination therapy for LUTS/BPH, sexual dysfunction, and other age-associated comorbidities are needed to establish new approaches to the optimal management of these conditions in aging men.

Lower urinary tract symptoms and male sexual dysfunction in Asia: a survey of ageing men from five Asian countries

To determine, using the Asian Survey of Aging Males (ASAM), the prevalence of lower urinary tract symptoms (LUTS) and sexual disorders in Asian men aged 50-80 years, and to investigate the relationship between LUTS and sexual dysfunction, as community-based studies have shown a relationship between LUTS and sexual dysfunction. The ASAM survey was conducted in selected cities in five Asian countries, using a combination of face-to-face and mail-survey methods. The survey evaluated demographics, urinary symptoms (using the International Prostate Symptom Score, IPSS, and bother score), functional problems (using the Danish Prostatic Symptoms Score, DAN-PSS-Sex, and International Index of Erectile Function, IIEF) and comorbidity factors. In all, 1155 men aged 50-80 years completed the survey. The prevalence of LUTS varied among the countries, ranging from 14% in Singapore to 59% in the Philippines. Moderate to severe LUTS were reported by 36% of men aged 50-59 years, 50% aged 60-69 years and 60% aged 70-79 years. About three-quarters of all respondents (72%) aged 50-80 years were sexually active. Erectile dysfunction was reported by 63% of men in the study, of whom 57% were bothered by their symptoms. Ejaculation disorders were present in 68% of respondents (52% reported bothersomeness) and pain on ejaculation was experienced by 19% of the men in the study (88% reported bothersomeness). Sexual disorders increased with age and increasing severity of their LUTS. Erectile and ejaculation problems were more common in subjects with diabetes or hypertension; these two groups showed the same relationship between LUTS severity and sexual disorders. These results confirmed that sexual activity is common in Asian men aged 50-80 years, even at an advanced age. They also confirmed the correlation between LUTS and sexual dysfunction.

Correlation between LUTS (AUA-SS) and erectile dysfunction (SHIM) in an age-matched racially diverse male population: data from the Prostate Cancer Awareness Week (PCAW)

The relationship between lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia and sexual health in men participating in a national multicenter screening program was studied. A total of 12 679 men were screened for prostate cancer in the year 2003. Of these, 6641 men had completed both the American Urological Association Symptom Score (AUA-SS) and the Sexual Health Inventory for Men (SHIM) questionnaires. We assessed the apparent effect of comorbidities (ischemic heart disease, hypertension, hypercholesteremia and diabetes), smoking habits and testosterone level on the overall sexual health. Age and race were also assessed as factors affecting the SHIM score. We used a general linear multivariable regression analysis to express the effect of these variables on the sexual health in these men adjusting for the apparent effect of LUTS. The mean and median age of the population was 58.4 +/- 9.8 and 58 y, respectively. The median AUA-SS was 4/25 (mean=5.7 +/- 5.3) and SHIM score was 19/25 (mean=16.3 +/- 5.9). Of the men, 4948 (75%) were Caucasian and 1154 (17%) were from African-American racial origin. A high AUA-SS appears to have a negative effect on the overall sexual health (P<0.05) after adjusting for all other confounding factors. As expected, age showed a significant inverse correlation with SHIM score (P<0.05). Caucasian men on average appear to have a significantly higher SHIM score by 6.5 points when compared to African-American men after adjusting for age, comorbidities, smoking habits, and AUA-SS (P<0.05). However, with increasing age, the difference in SHIM score diminishes between the two groups. Further, smoking and comorbidities were strong predictors of poor sexual health performance. Interestingly, hypogonadism (testosterone <300 ng/dl) was not a significant risk factor (P=0.104) when adjusting for all other variables. Nonetheless, in a univariate analysis, testosterone levels significantly correlated with reported SHIM scores (P<0.05). The overall sexual health in aging men is substantially affected not only by age, but by the severity of their urinary symptoms after adjusting for the most common known risk factors, suggesting perhaps a common underlying pathophysiology. Moreover, race appears to constitute another neglected potential risk factor, which should be investigated further in future studies.

Interrelation of erectile dysfunction and lower urinary tract symptoms

The association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) has garnered attention as investigators have hypothesized a common pathophysiology to explain the assertion that they are causally linked. This relationship between LUTS and ED has received increased attention because both diseases are highly prevalent, frequently co-associate in the same aging male group, and significantly influence the overall quality of life. A causal association between LUTS and ED cannot be established on the basis of the ever-increasing number of epidemiological studies. Attempting to explain a causal relationship between ED and LUTS requires the use of Hill's criterion, which is used by many epidemiologists to separate causal from non-causal explanations. A review of the epidemiological evidence reveals a strong degree of association, internal consistency and dose response effects between ED and LUTS. The temporal relationships between the two remain unknown because of the strong cross-sectional flavor of the epidemiological studies. The issue of an "alternate explanation" to describe the LUTS-ED association appears to be accounted for in that several large studies have provided convincing multiple regression analyses in which the ED-LUTS relationship remains significant. Biologic plausibility is an important issue if the link between ED and LUTS is to have credence. There are four leading theories of how these diseases interrelate. These explanations have a variable amount of supporting data. These include: 1) autonomic hyperactivity effects on LUTS, prostate growth and ED; 2) nitric oxide synthase/nitric oxide levels decreased or altered in the prostate and penile smooth muscle; 3) prostate and penile ischemia; and 4) increased Rho-kinase activation/ endothelin activity. LUTS and sexual dysfunction are highly prevalent in aging men. Both conditions are also significant contributors to overall quality of life. New data has emerged to indicate potential links in epidemiological, physiologic, pathophysiologic and treatment aspects of these two diseases. Using Hill's causality method to separate causal from non-causal explanations linking ED with LUTS, it appears that most epidemiological components are fulfilled.

Male Sexual Health Questionnaire (MSHQ): Scale development and psychometric validation

Objectives To validate a new, self-administered questionnaire for assessing key domains of sexual function and satisfaction in aging men with urogenital health concerns. Methods The initial items were identified by patient interviews, review of current reports, and expert panel solicitation. The resulting 25-item questionnaire was subjected to psychometric evaluation and refinement using two discriminant validity studies in aging men with urogenital symptoms compared with age-matched controls. Psychometric tests of reliability, discriminant, and criterion validity were performed. Results Qualitative testing revealed adequate comprehension and content validity of the initial item set. Two domains of sexual function (ejaculation, erection) were identified in the first discriminant validity study, each of which showed a high degree of internal consistency (alpha = 0.81 and alpha = 0.90, respectively) and test-retest reliability ( r = 0.86 and r = 0.87, respectively). Both sexual function domains discriminated well between men with and without urogenital manifestations of lower urinary tract symptoms (LUTS) and sexual dysfunction ( P <0.001). An additional domain of sexual satisfaction was added in the second validation study, with similarly high internal consistency (alpha = 0.90) and test-retest reliability ( r = 0.88). Tests of convergent and divergent validity, including correlations with standardized scales for depression (Center for Epidemiologic Studies–Depressed Mood Scale), sexual function (International Index of Erectile Function), and life satisfaction (Fugl-Meyer), confirmed the criterion validity of the new measure. Conclusions The Male Sexual Health Questionnaire assesses sexual function and satisfaction in older men with urogenital symptoms of LUTS and sexual dysfunction. This new instrument has excellent psychometric properties and is well suited for use in clinical and research settings.

The relationship between erectile dysfunction and lower urinary tract symptoms: epidemiological, clinical, and basic science evidence.

Lower urinary tract symptoms (LUTS) and sexual dysfunction are highly prevalent in aging men. Both conditions also are significant contributors to overall quality of life. New data have emerged to indicate potential links in epidemiological, physiologic, pathophysiologic, and treatment aspects of these two entities. There are numerous publications based on sophisticated community and clinical-based data, suggesting a strong and consistent association between LUTS and erectile dysfunction (ED). The association is supported by the consistent linear relationship of more severe LUTS with more severe ED. The link between ED and LUTS has biologic plausibility given the four leading theories of how these diseases inter-relate.

Lower urinary tract symptoms (LUTS) and sexual function in both sexes.

It has been stated that lower urinary tract symptoms (LUTS) do not affect sexual function to any significant degree, but a recent study has suggested that there might be an association in men. The present study was conducted to investigate the relationship between LUTS and sexual problems in both men and women aged 40-65 years. The survey was conducted in Denmark between May and June 2003. Detailed questionnaires were mailed to a random sample of 15,000 men and women aged 40-65 years. LUTS and sexual function were assessed by validated symptom scales. Multivariate regression analysis was performed using logistic regression for dichotomous dependent variables of sexual function. The independent variables for both sexes were age, LUTS, partner status, body mass index (BMI), alcohol consumption and co-morbidities. A total of 15,000 questionnaires were mailed out, 8491 were completed and returned, and 7741 were deemed valuable and included in the analysis. LUTS and sexual dysfunction were common in both men and women. Logistic regression analysis of items related to erection problems and satisfaction with sex life in men and sexual function in women showed that LUTS are an independent risk factor for sexual dysfunction in both men and women aged 40-65 years. Significant effects on sexual function were also found for the independent variables of partner status and co-morbidities. The presence of LUTS is an independent risk factor for sexual dysfunction in men and women. These results highlight the clinical importance of evaluating LUTS in patients with sexual dysfunction, and the need to consider sexual issues in the management of patients with LUTS.

LUTS and Sexual Dysfunction: Implications for Management of BPH

Objectives: To summarise currently available data describing the impact of surgical and pharmacological treatments for lower urinary tract symptoms (LUTS) on male sexual function. To compare treatment options and outline implications for the management of this patient group. Methods: Key published studies and newly emergent assessments evaluating individual treatments for benign prostatic hyperplasia (BPH) and/or LUTS were reviewed. Results: Differences exist between available treatment options for LUTS with respect to impact on sexual function. Surgical procedures, including minimally invasive treatments, are associated with ejaculation and erectile dysfunction. Differences between classes of drug treatments are also evident; α 1-adrenoceptor blockers demonstrate the least adverse effects on sexual function. Conclusions: Preservation of sexual function is important in the maintenance of quality of life for ageing male patients with LUTS, and should be considered in physicians’ treatment decisions. Potential effects of treatment options on sexual function should be discussed with patients before starting therapy.

The association between lower urinary tract symptoms and erectile dysfunction in four centres: the UrEpik study.

To report a large-scale multinational investigation of lower urinary tract symptoms (LUTS) and sexual function, designed to investigate the independent association between them, as recent small-scale epidemiological studies suggest an association between benign prostatic hyperplasia and sexual dysfunction; both conditions are strongly associated with age and no study has been able to exclude age as a confounding factor in this relationship. Culturally and linguistically validated versions of standard questionnaires were used to estimate the prevalence of LUTS (using the International Prostate Symptom Score, IPSS) and erectile dysfunction (ED) score (using O'Leary's Sexual Function Inventory) in regions of the UK (Birmingham), the Netherlands (Boxmeer), France (Auxerre) and Korea (Seoul). In each centre, stratified random samples were selected from population registers to provide representative samples of the population of men aged 40-79 years (and their partners) in each community. Direct interviews were held in Seoul and postal questionnaires used in the three European centres. The samples were selected randomly, providing representative samples in each community. In all, 4800 men and 3674 women responded; the response rates among men were 77% in Boxmeer, 21% in Auxerre, 42% in Birmingham and 65% in Seoul. The overall prevalence of ED for men aged 40-79, estimated as an ED score of 0-4, was 21.1%. There was evidence of a linear increase with age (P < 0.001) and the pattern was very similar in the four centres. From the weighted logistic model, there was evidence of an association between sexual dysfunction, other self-reported diseases and lifestyle. From the ED score, after adjusting for age and country, men with diabetes were more likely to score of 0-4 (odds ratio 1.57, 95% confidence interval 1.09-2.25), as were those with high blood pressure (1.38, 1.09-1.75) and with an IPSS of 8-35 (1.39, 1.10-1.74). For lifestyle, smokers were more likely to score 0-4 (1.54, 1.23-1.92), while physical activity during leisure time was slightly associated with a reduction in the chance of scoring 0-4 (0.87, 0.77-0.99). The analysis gave the same results when repeated using self-reported ED instead of the dichotomised score. ED is clearly age-related and a problem for a large proportion of men in the community. It can have a profound impact on the quality of life of the man and on his partner. Were all men with this problem to seek medical help there would be a large burden on healthcare systems. There are cultural and age effects on the assessment of this problem.