Prevalence of erectile dysfunction in men with lower urinary tract symptoms/benign prostatic hyperplasia: a systematic review and meta-analysis.

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.