Table 1.
Epidemiological evidence from community studies (ranked by sample size)
| Reference | Country/ies | Sample n | Relevant results for an association between ED and LUTS |
|---|---|---|---|
| McVary et al. (62) | USA | 81,659 | The baseline prevalence of recorded BPH was 1.5% among men with ED. During the follow-up period (mean 2.2 years), 7.6% had documented BPH |
| Rosen et al. (30) MSAM-7 | USA and six European countries | 12,815 | Sexual disorders and ‘bothersomeness’ were strongly related to both age and severity of LUTS. When controlling for age, LUTS severity was by far the strongest predictor of ED, with an odds ratio for severe versus mild LUTS of 8.90 (6.85–11.55) |
| Wein et al. (19) EpiLUTS | USA, UK, Sweden | 11,834 | 26% of men with LUTS had mild to severe ED; men with multiple LUTS had more severe ED and more frequent EJD and PE |
| Morant et al. (31) | UK | 11,217 | Compared with men with no LUTS, odds ratios (95% CI) for ED were as follows: storage LUTS 3.0 (2.6–3.4); voiding LUTS 2.6 (2.4–2.7); and both voiding and storage LUTS 4.0 (3.4–4.8). Among the 11,327 men with any recorded LUTS and ED, LUTS diagnosis preceded ED in 63.1% of patients by a mean of 4.8 years |
| Rosen et al. (63) | USA | 6924 | In 3084 sexually active men, age, total IPSS, IPSS bother score, hypertension, diabetes and black race/ethnicity were independent predictors of both ED and EJD (all p < 0.05) |
| Braun et al. (3) | Germany | 5000 | LUTS was an independent risk factor for ED: LUTS prevalence 72.2% in men with ED, 37.7% in men without ED |
| Boyle et al. (4) UrEpik | UK, the Netherlands, France and Korea | 4800 | Diabetes (odds ratio of 1.57, 95% CI: 1.09–2.25) liver problems 1.55 (1.03–2.33); LUTS 1.39 (1.10–1.74); and hypertension 1.38 (1.09–1.75) were significantly correlated with ED |
| Blanker et al. (64) Krimpen Community Cohort | The Netherlands | 3924 | ED relative risk of 1.8–7.5 for increasing urinary complaints; risk of ED greater with LUTS than with smoking or cardiac symptoms |
| Hansen (65) | Denmark | 3442 | Logistic regression analysis showed LUTS was an independent risk factor for sexual dysfunction in men aged 40–65 years |
| Ponholzer et al. (66) | Austria | 2858 | The presence of LUTS was an independent risk factor for the presence of ED; in multivariate analysis controlling for age, co-morbidities and lifestyle, the IPSS (p = 0.0001), the obstructive score of the IPSS (p = 0.0001), nocturia (p = 0.04), and the LUTS bother score (p = 0.002) correlated with the presence of ED (IIEF-5 score < 22) |
| Rosen et al. (51) BACH survey | USA | 2301 | ED was significantly associated with LUTS, nocturia and prostatitis in bivariate associations, and with prostatitis in multivariate analyses, controlling for the effects of diabetes and other co-morbidities |
| Chung et al. (67) | USA | 2115 | Sexual function domains of LUTS severity questionnaire were inversely associated with the severity of LUTS (all p < 0.001) |
| Macfarlane et al. (68) | France | 2011 | Sexual satisfaction had a negative correlation with LUTS: IPS score 0 = relative risk 1, IPSS score > 19 relative risk 3.3 |
| Frankel et al. (69) | UK + 12 others | 1694 | Sexual dysfunction was strongly associated with LUTS |
| Blanker et al. (64) | The Netherlands | 1688 | Multiple logistic regression analyses showed the following correlated with ED: age, smoking, obesity, LUTS, treatment for cardiovascular problems and COPD |
| Shiri et al. (32) | Finland | 1683 | Relative risk of LUTS was higher in men with moderate ED (relative risk of 1.5, 95% CI: 1.0–2.3) or severe ED (relative risk of 2.3, 95% CI: 1.4–3.8) than in those free of ED |
| Song et al. (70) | China | 1644 | The total IIEF-5 score significantly correlated with the total IPSS score (p < 0.01), the severity of LUTS correlated with the severity of ED (p < 0.01) |
| Vallancien et al. (71) | Europe | 1274 | ED was strongly related to age, lower urinary tract symptom severity, body mass index, hypertension and concomitant treatment with calcium channel antagonists; 70% of patients with severe LUTS had ED |
| Li et al. (72) Asian Survey of Aging Males (ASAM) | Asia | 1155 | Sexual disorders increased with age and increasing severity of LUTS. Erectile problems were present in 33%, 61% and 87% of men with no or mild LUTS aged 50–59, 60–69 and 70–80 years, respectively, and in 54%, 84% and 91% of men with moderate to severe LUTS |
| Ströberg et al. (73) | Sweden | 924 | Significant correlation between the IIEF-5 score and IPSS (p < 0.001) and the IIEF-5 score and LUTS-induced bother (p < 0.001) |
| Moreira et al. (74) | Brazil | 602 | LUTS were significantly (p < 0.05) associated with increased prevalence of ED |
| El-Sakka (75) | Egypt | 476 | LUTS were significantly associated with ED with a significant association between the increased severity of LUTS and the increased severity of ED |
| Ozayar et al. (76) | Turkey | 453 | ED was reported in 36% of men with moderate LUTS and in 94% with severe LUTS (p < 0.001). The odds ratio for ED was 28.7 for severe LUTS |
| Tsao et al. (77) | Taiwan | 398 | The prevalence of moderate to severe ED (IIEF-5 < 12) was significantly associated with LUTS severity (p < 0.05). A consistent inverse correlation was found between IIEF-5 and IPSS severity across the age groups, with the strongest effect observed in patients aged 60–69 years (p < 0.01) |
| Mehraban et al. (78) | Iran | 357 | Sexual dysfunction, defined as IIEF score of ≤ 20, was present in 68.2% of LUTS patients. All IIEF domain scores and the overall score were correlated with age (p < 0.001) and the IPSS (p < 0.001) |
| Wong et al. (79) | China | 352 | In multivariate analysis, moderate LUTS was independently associated with increased odds of having ED (odds ratio of 3.7, CI: 1.6–8.3) |
| Tsai et al. (80) | Taiwan | 339 | In multiple logistic regression analysis, age and IPSS (p < 0.001 and p = 0.013, respectively) were significantly associated with ED after controlling other co-morbidities |
| Wang et al. (81) | China | 245 | ED incidence significantly correlated with the severity of LUTS (p < 0.01); 71.3%, 89.6% and 95.8%, respectively, in the groups with mild, moderate and severe LUTS |
| Nakamura et al. (82) | Japan | 220 | The total IIEF-5 score significantly correlated with both the IPSS and CLSS questionnaires (p = 0.0001) |
| Rhoden et al. (83) | Brazil | 192 | Overall IPSS scores were significantly associated with ED (p = 0.002) and there was an association between the severity of ED and LUTS (p = 0.008). Logistic regression analyses showed that IPSS scores and ED remained independently associated even after controlling for confounding factors (p = 0.01) |
| Demir et al. (84) | Turkey | 190 | In the severe LUTS patient group, IIEF erectile function domain scores were significantly lower than in the moderate LUTS patient group (p < 0.05). Multiple logistic regression analysis confirmed that presence of ED was the most significant predictor of severe LUTS |
| Elliott et al. (85) | USA | 181 | A consistent negative correlation was found between obstructive IPSS and the SHIM score across age groups, with the strongest effect observed for men aged 60–70 years (p = 0.003) |
| Ikuerowo et al. (86) | Nigeria | 132 | The second question in the IIEF-5 questionnaire (How would you rate your ability to have an erection hard enough for penetration?) showed a significant correlation with total IPSS score (p = 0.022). The sum of the IPSS obstructive symptoms scores showed a significant correlation with ED scores (p < 0.001) |
| Glina et al. (87) | Brazil | 118 | Significant correlation between the IPSS and the SHIM (p < 0.001) |
ED, erectile dysfunction; LUTS, lower urinary tract symptoms; BPH, benign prostatic hyperplasia; EJD, ejaculatory dysfunction; PE, painful ejaculation; CI, confidence interval; IPSS, International Prostate Symptoms Score; IIEF, International Index of Erectile Function; COPD, chronic obstructive pulmonary disease.