The link between LUTS and ED: clinical and basic science evidence.

Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are extremely prevalent in aging men. LUTS describes the symptoms that occur with dysfunction of micturition. Both storage and emptying symptoms occur. Storage symptoms refer to urinary frequency, urgency, urge incontinence, nocturia, and dysuria. Emptying symptoms include hesitancy, straining, decreased force of stream, and incomplete emptying of the bladder, including urinary retention (Wein, 1981). BPH refers specifically to the histologic benign proliferation in the prostate gland, which may or may not be associated with LUTS. Erectile dysfunction (ED) is also an extremely common problem in older men. ED is defined as the consistent inability to maintain a penile erection sufficient for adequate sexual relations (NIH, 1993). The purpose of this review is to explore the link between the 2 conditions. Simply as a result of their predominance in older men, these 2 conditions are very likely to coexist. But is age the only link between LUTS and ED? Several other hypotheses exist that link LUTS and ED. First, some have postulated that the negative impact that LUTS has on the quality of life causes ED. Second, other studies have examined the role of a hyperadrenergic state in the pelvis associated with LUTS that adversely affects erectile function. Third, pharmacotherapy for BPH may affect erectile function. Finally, in the past, invasive therapy for BPH was thought to cause ED. This paper will explore the pathophysiologic link between LUTS and ED.