Association between the bothersomeness of lower urinary tract symptoms and the prevalence of erectile dysfunction

To assess the association between the bothersomeness of lower urinary tract symptoms (LUTS) and the prevalence of erectile dysfunction (ED).

The target population comprised all men born in 1924, 1934, or 1944 and residing in Tampere or 11 surrounding municipalities in Finland in 1999. A questionnaire was sent in May 1999 to 2,864 men, and 2,133 (75%) responded. Of them, 417 were excluded because of missing data on erectile function, or because they had prostate cancer or radical prostatectomy, leaving a total of 1,716 (60%) qualified respondents. LUTS was assessed by the Danish Prostatic Symptom Score, and ED by a short form of the International Index of Erectile Function. Logistic regression model was used in the multivariate analysis.

Adjusted odds ratios (ORs) of ED were 2.6 (95% CI 1.3-5.2) for men with LUTS total scores of 11-19 compared with men without LUTS and were not bothered by them, and 4.4 (2.1-8.9) for those with scores 20 or more. Bother scores 1-3 and 4-6 were significantly associated with ED (OR 1.8, 95% CI 1.2-2.6 and 2.1, 1.4-3.4, respectively), while similar symptoms scores were not. Adjusted ORs of ED was 4.1 (2.0-8.2) for men with a symptoms score of 10 or more compared with those free from symptoms, and same (OR 4.2, 95% CI 2.7-6.7) for men with similar bother score. Among symptoms, nocturia (adjusted OR 1.5), weak stream (OR 1.5), stress incontinence (OR 2.1), and overflow incontinence (OR 1.8) were significantly associated with ED, whereas among bother, only overflow incontinence (OR 2.2) was significantly correlated with ED.

ED is a common problem in men with LUTS and is strongly associated with both the severity of symptoms and their bothersomeness. However, bother of mild LUTS affects ED more than the mild symptoms, emphasizing the potential of psychological mechanisms of ED.