LUTS and Sexual Dysfunction: What is the Link and How Can it Be Managed?

Sexual dysfunction (SD) and lower urinary tract symptoms (LUTS) are both common in ageing men. It is clear that the relationship between these two groups of symptoms is more than epidemiologic; SD is positively associated with more severe LUTS. A number of hypotheses have been formulated that can potentially explain common pathophysiologic roots for LUTS and SD, but at present it remains unclear whether some, or all of these, are significant. Certain classes of medical therapy may benefit both LUTS and SD, but such hypotheses need testing in robust clinical studies. From a clinical perspective, a thorough understanding of the patterns of effect of different treatment modalities for LUTS on sexual function is important to provide guidance to men seeking therapy for LUTS. Ensuring that a sexual history is part of baseline patient assessment in men with LUTS is essential given the high prevalence in this group and its significance to patients. Although this may help identify any underlying comorbid conditions (such as diabetes mellitus) associated with erectile dysfunction, it will also help to guide the choice of therapy in men with and without SD. It is important to be cognisant that the overall incidence of new events with any treatment modality for LUTS, with the exception of retrograde ejaculation observed with transurethral resection of the prostate, is relatively low in comparison with the high prevalence associated with advancing age. The benefits of therapy are therefore likely to significantly outweigh the risks of SD in many men.