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Summary
There is little evidence to support a link between benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Any apparent relationship may reflect the fact that both are common conditions with a similar gender and age distribution. However, the surgical treatment of BPH (eg. TURP or open prostatectomy) may cause ED as a postoperative complication in some patients. Similarly, the medical treatment of BPH with finasteride may be associated with ED (< 5 % in one study). However, alpha-blockade is not associated with this side-effect.
Introduction
It has long been speculated that there is an association between benign prostatic hyperplasia (BPH) and erectile dysfunction. The source of this speculation is the fact that patients often complain of symptoms of both. However, it is unclear whether or not this is a real association, or simply a reflection of the increasing prevalence of both urinary symptoms and erectile failure in ageing men.
How might BPH impact on erectile status? Firstly there could be some anatomical basis, but this would seem unlikely. Secondly, nocturia and consequent sleep disturbance could impact on the REM (rapid eye movement) phase and pattern of sleep generally: it is increasingly well recognised that normal sleep is important in erectile function. Thirdly, if quality of life is reduced in general this will impact on other domains of normal function, and erectile status appears to be particularly vulnerable to this type of influence. Finally, treatments for BPH may impact on erectile function; this is perhaps the one area that has been extensively researched.
The purpose of this review is to focus on the evidence for and against an association between BPH and erectile dysfunction. The literature cited was obtained by a MedLine search and subsequent secondary reference checks.
Published Reviews
In a literature search of papers evaluating health-related quality of life (HRQOL) scores and sexual dysfunction versus disease of the prostate, Burger et al. found an association between prostatodynia and erectile dysfunction1. There was an association between treatments for BPH and specific aspects of sexual functioning (such as ejaculation), but no correlation between erectile dysfunction and BPH itself. The prostatic disease with the greatest impact on sexual functioning was prostate cancer. These results are consistent with a previous study...