Relationship Between Erectile Dysfunction and International Prostate Symptom Score

Introduction: Erectile dysfunction (ED) refers to inability to achieve and sustain erection sufficient for satisfactory penetrative sexual experience. Lower Urinary Tract Symptoms (LUTS) includes storage, voiding and post-micturition symptoms due to bladder outlet obstruction. LUTS may be a risk factor for ED. Objectively, international prostate symptoms score (IPSS) is an essential tool for assessing the bothersome nature of lower urinary tract symptoms while the abridged version of international index of erectile function (IIEF-5) is objectively useful in assessing ED. This study is focused on establishing the relationship between severity of ED and IPSS in patients with bladder outlet obstruction (BOO) caused by prostate enlargement. Methodology: By simple random sampling, patients presenting in clinic with bladder outlet obstruction not due to urethral stricture were evaluated for ED. Two questionnaires (IIEF-5 and IPSS) and a specially designed proforma were administered to all the patients who met the criteria for inclusion. The questionnaires objectively evaluated the ED and severity of LUTS respectively. The data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. P-value of < 0.05 was seen as statistically significant. Results: One hundred and seventeen male patients with bladder outlet obstruction were enrolled in this study. Ninety patients (77%) varying severity of IIEF-5 score while twenty-seven patients (23%) normal IIEF-5 score. Mean age of patients with severe IIEF-5 score was 64 while the mean age of patients with moderate IIEF-5 score, mild to moderate IIEF-5 score, mild IIEF-5 score and normal IIEF-5 score were 64, 65, 60 and 58 respectively. Over seventy one percent (71.4%) of patients between 41-50 years had varying degree of ED based on IIEF-5 score. 65% of patients between the age range of 51-60 abnormal IIEF-5 score while 89% and 94% of patients between the age range of 61-70 and 71-80 respectively varying degree of ED. Patients with severe IIEF-5 score had the highest mean IPSS of 23 while patients with normal IIEF-5 score had the lowest mean IPSS. The P-value (0.21) was not significant. Conclusion: This study shows that IIEF-5/ED has a direct relationship with IPSS. There was a positive link between ED/IIEF-5 and IPSS/LUTS. This may also be part of the rationale for administering low dose tadalafil to improve sexual performance in patients with bladder outlet obstruction.