There is increasing evidence to suggest that moderate-to-severe LUTS are linked with erectile dysfunction. A recent large-scale study known as the Multinational Survey of the Aging Male (MSAM-7), which surveyed 12 815 men in the USA and Europe (France, Germany, Italy, Netherlands, Spain, and the UK), showed that the prevalence of sexual dysfunction increased with LUTS severity, independently of age (see ). The link between LUTS and sexual dysfunction is poorly understood, although a number of common components have been identified such as upregulation of ^-adrenoceptor activity, alteration in a1-adrenoceptor subtypes, decreased NO bioactivity, and sex hormone imbalance. ^-Adrenoceptors are involved in the maintenance of smooth muscle contraction and relaxation in penile tissue. It has been suggested that any impairment of these receptors and their regulators such as the Rho/Rho-kinase pathway will contribute to smooth muscle dysfunction, which is evident in both LUTS and erectile dysfunction. Endothelium dysfunction as a result of ROS-induced NO breakdown can also contribute to LUTS and erectile dysfunction. Testosterone alterations are well established as a cause of BPH and LUTS, and it is likely that any androgen imbalances may also lead to erectile dysfunction. For more information on sexual dysfunction, see Chapter 6.23.
Figure 11 The percentage of lower urinary tract symptoms (LUTS) occurring 'more than half the time' in a population of men from Sweden (n = 39 928) stratified by age. (Reproduced with kind permission from Andersson, S.-O.; Rashidkhani, B.; Karlberg, L.; Wolk, A.; Johansson, J.-E. BJU Int. 2004, 94, 327-331 © 2004 Blackwell Publishing.)
Base: Men who have erections
Figure 12 The relationship between lower urinary tract symptom (LUTS) severity and ejaculatory dysfunction (assessed via DAN-PSS) in relation to age. (Reproduced with kind permission from Rosen, R. C.; Altwein, J.; Boyle, P. et al. Eur. Urol. 2003, 44, 637-649.)
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