Erectile dysfunction and lower urinary tract symptoms in men with multiple sclerosis

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system commonly associated with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED); however, these conditions remain underinvestigated in Brazilian populations.

To evaluate the prevalence of ED and LUTS, to analyze the correlations involving the 5-item International Index of Erectile Function (IIEF-5), the International Prostate Symptom Score (IPSS), the Expanded Disability Status Scale (EDSS), age, and disease duration, and to identify the subscale items most strongly associated with neurological disability in men with MS.

We conducted a cross-sectional study enrolling 56 men with MS diagnosed through the McDonald criteria at the Reference Center for MS of the state of Paraíba, Brazil. Erectile dysfunction was assessed using the IIEF-5, and LUTS, using the IPSS. Spearman correlations with Bonferroni correction, univariate linear regression, one-way analysis of variance (ANOVA), and Tukey's Honestly-Significant Difference (HSD) post-hoc tests were performed.

The mean age of the sample was 39.9 ± 12.3 years, the median EDSS score, 2.75, and the median disease duration, 7 years. The prevalence of ED was of 50%, and that of LUTS, 96.4%. Strong correlations were found between the scores on the EDSS and the IIEF-5, the EDSS and the IPSS, and the IIEF-5 and the IPSS. Through the analysis, we identified erection confidence and urinary intermittency as the subscale items most strongly associated with the EDSS score. One-way ANOVA revealed significant differences across MS phenotypes for the IIEF-5, IPSS, and EDSS, with Tukey HSD confirming relapsing-remitting MS versus secondary progressive MS as the primary source of divergence.

Erectile dysfunction and LUTS were highly-prevalent in men with MS in the cohort of the present study. Disability level was the strongest correlate of both dysfunctions, supporting integrated urological-neurological screening in MS care.