INTRODUCTION: Erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) commonly coexist in aging men through shared vascular and neuroregulatory pathways, yet prevalence estimates vary widely across income settings. OBJECTIVES: The objective of this study was to estimate the pooled prevalence of ED in men presenting with lower urinary tract symptoms (LUTS)/BPH across clinical settings in high-income countries (HICs) and low- and middle-income countries (LMICs), and to narratively describe associated clinical and demographic factors reported within the included studies. METHODS: Following PRISMA guidelines, we searched 4 sources (Scopus, PubMed, Web of Science, and Lens.org) for English-language observational studies published between 2010 and 2025 reporting ED prevalence in men with LUTS/BPH. Two reviewers independently screened titles/abstracts and full texts, extracted data, and assessed risk of bias. A random-effects meta-analysis with logit-transformed prevalence estimates was conducted, with subgroup and sensitivity analyses used to explore heterogeneity. RESULTS: Eleven studies (n = 1254 men with LUTS/BPH) from 9 LMICs and 2 HICs yielded a pooled ED prevalence of 79.53% (95% confidence interval CI, 71.63%-85.74%; I2 = 51.51%, P = .014), ranging from 60.0% (Morocco) to 98.7% (Bosnia and Herzegovina). LMICs showed higher rates (78.7%) than HICs (70.9%), though CIs overlapped. Tests of funnel-plot asymmetry suggested possible small-study effects, but these findings were interpreted cautiously given the limited number of studies. Narrative evidence suggested that age >60 years, LUTS, and cardiometabolic comorbidity were commonly reported correlates of ED. Conclusion: ED is highly prevalent among men with LUTS/BPH presenting in hospital- or clinic-based settings. These findings support routine consideration of sexual health assessment in men presenting with LUTS/BPH, while underscoring the need for prospective studies using standardized diagnostic criteria and broader sampling frames. REGISTRATION: PROSPERO CRD420251145482 https://www.crd.york.ac.uk/PROSPERO/view/CRD420251145482.
Bukyana et al. (2026) studied this question.