A Prospective Study of Lower Urinary Tract Symptoms and Erectile Dysfunction

Abstract

Several studies have reported that men with lower urinary tract symptoms (LUTS) are more likely to experience erectile dysfunction (ED). All but one of these studies was cross-sectional, limiting inferences about whether LUTS precipitate ED. The association between LUTS and incident ED was examined prospectively in the Health Professionals Follow-up Study. LUTS were assessed biennially by the American Urological Association Symptom Index, which captures symptoms of frequency, urgency and force of urinary stream. Severe LUTS was defined as a symptom score of ≥ 20 points and no LUTS was defined as a score of ≤ 7 points, both among men not treated for LUTS. In 2000, the men were asked to rate their erectile function for several time periods. ED was defined as “poor” or “very poor” function or use of ED medications and no ED was defined as “very good” or “good” function and no use of ED medications. We estimated risk ratios using Poisson regression adjusting for age and other potentially confounding factors. We observed 3,953 incident ED cases among 17,086 men. Men with severe LUTS in 1994 or earlier had a statistically significant 40% higher risk of ED subsequently than men without LUTS. The risk of ED increased with increasing LUTS severity (p trend < 0.0001). The positive association between LUTS and ED was stronger among younger than older men (p interaction = 0.03). This study provides evidence that men with LUTS are more likely to develop ED subsequently.