Relationship between lower urinary tract symptoms and erectile dysfunction: results from the Boston Area Community Health Survey

Purpose: We explored the association of lower urinary tract symptoms and erectile dysfunction in a racially and ethnically diverse random sample of men. Materials and Methods: The Boston Area Community Health Survey used a stratified, 2-stage cluster sample to recruit 2,301 men representative of Boston. Data were obtained on symptoms suggestive of a number of urogynecologic conditions, comorbidities, and lifestyle and psychosocial factors. Results: The percent of men reporting moderate/severe lower urinary tract symptoms, as measured by the American Urological Association symptom index, ranged from 8% in those 30 to 39 years old to 26% in those 70 to 79 years old. The prevalence of erectile dysfunction was high and it increased dramatically with age with 10% of 30 to 39-year-old and 59% of 70 to 79-year-old men reporting mild-moderate/moderate/severe symptoms. A strong association was observed between the American Urological Association symptom index and erectile dysfunction after adjusting for age. However, after adjusting for other symptoms and comorbidities evidence of this association became weak. Much stronger associations were seen with incontinence, which is not included in the American Urological Association symptom index, and symptoms suggestive of prostatitis. When considering the American Urological Association symptom index symptoms separately, only nocturia increased the severity of erectile dysfunction. Stratified analyses demonstrated similar associations across race/ethnicity groups. Conclusions: Lower urinary tract symptoms and erectile dysfunction are common conditions in older men in the community. This study provides evidence to suggest that the previously observed association between erectile dysfunction and lower urinary tract symptoms may be primarily due to nocturia, incontinence and symptoms suggestive of prostatitis.