Correlations between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases: Are there differences between male populations from primary healthcare and urology clinics? A review of the current knowledge

Objective: To evaluate the correlation between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases in different male populations. Methods: Data sources: PubMed (Medline), clinical evidence, Embase, Cochrane reviews, and articles from reference lists. Selection criteria: Selection criteria in search databases were lower urinary tract symptoms, LUTS, comorbidity (MeSH), impotence (MeSH), sexual dysfunction, aging, primary care (MeSH), and male. Studies on these subjects, and concerning men aged 40 years or older, were eligible for inclusion in this review. Both community-based and clinical-based studies were included. Results: 20 studies were eligible for inclusion, representing 71 322 men. These studies showed a significant positive correlation between lower urinary tract symptoms and erectile dysfunction. The odds ratios varied from 1.4 to 9.74. All studies were community or clinical based. Just one study based on a primary care population was described. The association between erectile dysfunction and cardiovascular diseases is not proven in primary care. Conclusions: The evidence of a positive correlation between lower urinary tract symptoms and erectile dysfunction is significant in community-and clinical-based studies. It is at present unknown whether these correlations are significant in the patient population of primary healthcare. We need more evidence to prompt the general practitioner to screen every man with initial presentation of erectile dysfunction for standard cardiovascular risk factors and, as appropriate, start initial cardioprotective interventions.