title: [Lower urinary tract symptoms related to benign prostatic hyperplasia and erectile dysfunction: A systematic review].
abstract: OBJECTIVE
  To provide a systematic review of epidemiological data regarding the association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men.
  
  
  METHODS
  A research has been conducted on the Medline database using the keywords: ("erectile dysfunction" or "sexual dysfunction") and ("benign prostatic hyperplasia" or "lower urinary tract symptoms"). The eligibility of studies was defined using the PICOS method in accordance with the PRISMA statement. Cross-sectional studies and prospective cohorts assessing the association between LUTS and ED in the primary care setting or in general practice (i.e. exclusion of patients seen in outpatient urology or andrology) were included.
  
  
  RESULTS
  Among 898 reports assessed, seven studies were included in this systematic review (whole cohort: 1,196,393 men). There were five cross-sectional studies and two prospective cohorts. The whole seven studies reported an association between LUTS and ED (range of odds-ratio: 1.52-4.03). Four common pathogenic mechanisms were found in the literature, all of them being somewhat related with metabolic syndrome and cardiovascular risk factors: reduced nitric oxide (NO) pathway signalling, increased RhoA-Rho kinase signalling, autonomic nervous system hyperactivity and pelvic atherosclerosis.
  
  
  CONCLUSIONS
  The main limitations of this review were: a possible publication bias, the relatively low number of included studies and the lack of assessment of potential confounders such as factors related to sexual partner.
  
  
  CONCLUSIONS
  The close epidemiological and pathogenic links between LUTS and ED have given rise to a new nosological entity: the erectile urogenital dysfunction, which should be assessed globally with special considerations to frequently associated comorbidities such as metabolic syndrome and cardiovascular risk factors.
authors.affiliation: CHU de Rennes, service d'urologie, 35000 Rennes, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Assistance publique des Hôpitaux de Paris, hôpital Pitié-Salpétrière, service d'urologie, 47, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Assistance publique des Hôpitaux de Paris, hôpital Pitié-Salpétrière, service d'urologie, 47, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
authors.affiliation: Clinique Pasteur, service d'urologie, 33000 Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Misrai
authors.affiliation: Assistance publique des Hôpitaux de Paris, hôpital Henri-Mondor, service d'urologie, 94000 Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.affiliation: Assistance publique des Hôpitaux de Paris, hôpital Pitié-Salpétrière, service d'urologie, 47, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: mroupret@gmail.com.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006152:Cyclic GMP / Q000378:metabolism; D004730:Endothelium, Vascular / Q000378:metabolism; D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D018783:Impotence, Vasculogenic / Q000453:epidemiology / Q000503:physiopathology; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000378:metabolism; D009130:Muscle, Smooth / Q000503:physiopathology; D017942:Nitric Acid / Q000378:metabolism; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D015398:Signal Transduction; D054460:rho-Associated Kinases / Q000502:physiology; D020742:rhoA GTP-Binding Protein / Q000502:physiology
chemical_list: C066737:RHOA protein, human; D017942:Nitric Acid; D054460:rho-Associated Kinases; D020742:rhoA GTP-Binding Protein; D006152:Cyclic GMP