How can we best characterize the relationship between erectile dysfunction and benign prostatic hyperplasia?

Introduction. Considerable epidemiological literature exists, showing a relationship between voiding dysfunction and sexual dysfunction. However, few basic science or prospective data are available to determine the nature of the relationship between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction. Methods and Discussion. A critical evaluation of the nature of the relationship between LUTS and erectile dysfunction (ED) must include a look at the nature of the data establishing the relationship, precise definitions of the disease states being evaluated, and adherence to established normative relationships. Criteria for causality will be utilized to best determine the relationship between LUTS and ED. This article will attempt to take a critical and provocative look at where we are presently in establishing a relationship between voiding dysfunction and sexual dysfunction in order to better direct research efforts through evidence-based studies. Conclusion. At present, the epidemiological data do not support a causal relationship based on Hill's criteria for causality between LUTS and ED but suggest a less rigorous association. Additional research is needed to better characterize this relationship.