Lower urinary tract symptoms and erectile dysfunction; links for diagnosis, management and treatment

Abstract

Recent large-scale epidemiological studies have documented a strong association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). This observation has two important scientific and clinical aspects: (i) to reveal the pathomechanism linking LUTS and ED and (ii) to consider this fact in the individual approach for diagnosis and management of these two disorders. The following hypotheses are under investigation to explain the relation between LUTS and ED: (i) an increased Rho-kinase activation, (ii) an a-adrenergic receptor imbalance, (iii) a decrease of NOS/ NO in the endothelium, (iv) atherosclerosis affecting the small pelvis and (v) an autonomic hyperactivity, each affecting simultaneously bladder, prostate and penis. According to a recent randomized trial, sildenafil has a positive effect on LUTS yet not on uroflowmetry in men with LUTS and ED. Although further trials are mandatory, phosphodiesterase-5 inhibitors might play a role in the management of LUTS in the future. a-Blockers have no relevant effect on erectile function, tamsulosin leads to retrograde ejaculation in up to 10%. 5a-Reductase inhibitors are associated with ED, loss of libido and reduction of ejaculate volume in up to 10%. Transurethral and open prostatectomy induce retrograde ejaculation in up to 90% of patients while their impact on erectile function is still controversially discussed. Minimal invasive treatment options (laser prostatectomy, transurethral microwave thermotherapy) have a lower rate of retrograde ejaculation in the range of 20-70%. LUTS and ED are strongly linked although the exact mechanism is poorly understood. Men seeking for help for LUTS/benign prostatic hyperplasia should be assessed for different aspects of sexual dysfunction and informed regarding the impact of medication and surgery on sexual health.

Impact of Overactive Bladder Symptoms on Sexuality in Both Sexes

“…Previous studies have documented a clear association between LUTS and ED [12][13][14][15] . As OAB symptoms such as urgency, frequency and nocturia belong to the LUTS complex, a connection between OAB and ED seems likely.…”

Evaluation and treatment of male pelvic pain syndromes and sexual dysfunction

“…Tadalafi l treatment in men with BPH has improved symptoms in 56% of men, but no change in urine fl ow was noticed; further research in the role of 5-PDEI in MPPS is needed [ 40 , 45 ]. All three available 5-PDEIs have been evaluated in the treatment of LUTS, and although men with severe LUTS report improvement in symptoms, more data are needed to support the routine use of 5-PDEIs to manage men with LUTS [ 46 ]. 5-PDEIs may be more useful in ejaculatory dysfunction because they relax seminal vesicles in isolated strips experiments [ 47 ].…”

Dyspareunia and surgery: Can we measure sexual function and outcomes?

“…As has been demonstrated for men presenting with lower urinary tract symptoms (LUTS) [8], contemporary studies have found a correlation between LUTS, pelvic organ prolapse, and female sexual dysfunction [9,10]. By nature of their presentation for genitourinary problems, it is often a cumbersome task to establish a baseline for a patient's sexual function that can later be compared with outcomes of incontinence or prolapse surgery.…”