Lower urinary tract symptoms and erectile dysfunction

Both lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED) are highly prevalent, frequently coassociated, and significantly contribute to the overall quality of life. Numerous cross-sectional epidemiological studies have reported a clear and clinically significant association between LUTSs and ED in aging men worldwide. LUTSs were also demonstrated to be an independent risk factor for ED after controlling for age, comorbidities, and lifestyle factors. Four main pathophysiological mechanisms, including the nitric oxide (NO)/NO synthase (NOS) theory, autonomic hyperactivity, the Rho-kinase activation pathway, and pelvic atherosclerosis, currently support the relationship. New approaches were recommended to evaluate and manage both conditions and select treatment options. In addition to well-known treatment effects of α1-blockers and phosphodiesterase (PDE)-5 inhibitors, α1-blockers can also be beneficial in the treatment of ED, while PDE-5 inhibitors can be beneficial in the treatment of LUTSs. Combination therapy with both agents can improve LUTSs and/or ED via different mechanisms of action. Testosterone replacement therapy (TRT) with or without PDE-5 inhibitors was also reported to improve erectile function and LUTSs in hypogonadal men. Additional studies of combination therapy for LUTSs, ED, and other comorbidities are needed to establish new approaches to achieve optimal management of these conditions in aging men.