Treating Coexistent Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms and Erectile Dysfunction in the Aging Male

Abstract

Both lower urinary tract symptoms associated with benign prostatic hyperplasia and erectile dysfunction are highly prevalent in the aging male population, a prevalence that increases with age. Evidence now suggests there is an independent association between these two complaints, increasing the likelihood that men presenting with either will suffer coexistent benign prostatic hyperplasia/lower urinary tract symptoms and erectile dysfunction. Treating these men presents both pitfalls and opportunities to the physician. By treating pathophysiological pathways common to both, whilst avoiding medication adversely affecting sexual function, optimal improvements in symptomatology and quality of life can be achieved. This review examines the relationship between these two pathologies and the implications for pharmacological intervention.Lower urinary tract symptoms (LUTS) affect over 50% of the male population aged over 60 years, an incidence which increases with age and is largely attributed to benign prostatic hyperplasia (BPH).Incidence of sexual dysfunction (SD) is also particularly high in this group of patients, and is increasingly recognized as a source of significant concern and loss of quality of life, even within older age groups [1]. SD incorporates not only erectile dysfunction (ED), but also impairment of other components of sexual function such as ejaculation, orgasm, sexual drive and sexual satisfaction, factors considered highly significant to overall sexual function.These two conditions were originally thought to be independent of each other and attributed to aging, but recent studies suggest an association underpinned by a common pathophysiological etiology.This has important implications for the management of men with either BPH/LUTS or ED, and particularly for those with both. Medical intervention for either condition affects the other, with potential for both exacerbation and improvement of symptoms [2]. An understanding of both disease states is therefore important in the treatment of either and is reviewed here, along with common treatment options. Association between LUTS & SD EpidemiologyIn 1996, Macfarlane surveyed a sample of the French population [3], noting low sexual life satisfaction scores with increasing age and severity of LUTS, and found the association persisted even after controlling for age. These findings have been confirmed by subsequent studies (such as the UrEpik study [4] and the Cologne Male Survey [5]), which demonstrate that LUTS are independent risk factors for ED.The clinical significance of this association was underscored when the Alf-One study group also reported a relationship between ED and LUTS severity in clinic attendees [6]. In this group of men, with relatively high mean age and LUTS severity, they found a high prevalence of ED (62%), and identified age and LUTS as the main predictors of the condition.However, perhaps the most important study to date to examine this has been the Multinational Survey of the Aging Male [7]. This large, multinational survey gathered...