Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs R, Fourcade R, Kiemeney L, Lee C
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
BJU Int. 2003 Nov;92(7):719-25. doi: 10.1046/j.1464-410x.2003.04459.x.
To report a large-scale multinational investigation of lower urinary tract symptoms (LUTS) and sexual function, designed to investigate the independent association between them, as recent small-scale epidemiological studies suggest an association between benign prostatic hyperplasia and sexual dysfunction; both conditions are strongly associated with age and no study has been able to exclude age as a confounding factor in this relationship.
Culturally and linguistically validated versions of standard questionnaires were used to estimate the prevalence of LUTS (using the International Prostate Symptom Score, IPSS) and erectile dysfunction (ED) score (using O'Leary's Sexual Function Inventory) in regions of the UK (Birmingham), the Netherlands (Boxmeer), France (Auxerre) and Korea (Seoul). In each centre, stratified random samples were selected from population registers to provide representative samples of the population of men aged 40-79 years (and their partners) in each community. Direct interviews were held in Seoul and postal questionnaires used in the three European centres. The samples were selected randomly, providing representative samples in each community.
In all, 4800 men and 3674 women responded; the response rates among men were 77% in Boxmeer, 21% in Auxerre, 42% in Birmingham and 65% in Seoul. The overall prevalence of ED for men aged 40-79, estimated as an ED score of 0-4, was 21.1%. There was evidence of a linear increase with age (P < 0.001) and the pattern was very similar in the four centres. From the weighted logistic model, there was evidence of an association between sexual dysfunction, other self-reported diseases and lifestyle. From the ED score, after adjusting for age and country, men with diabetes were more likely to score of 0-4 (odds ratio 1.57, 95% confidence interval 1.09-2.25), as were those with high blood pressure (1.38, 1.09-1.75) and with an IPSS of 8-35 (1.39, 1.10-1.74). For lifestyle, smokers were more likely to score 0-4 (1.54, 1.23-1.92), while physical activity during leisure time was slightly associated with a reduction in the chance of scoring 0-4 (0.87, 0.77-0.99). The analysis gave the same results when repeated using self-reported ED instead of the dichotomised score.
ED is clearly age-related and a problem for a large proportion of men in the community. It can have a profound impact on the quality of life of the man and on his partner. Were all men with this problem to seek medical help there would be a large burden on healthcare systems. There are cultural and age effects on the assessment of this problem.
报告一项关于下尿路症状（LUTS）与性功能的大规模跨国调查，旨在研究它们之间的独立关联。因为近期小规模流行病学研究表明良性前列腺增生与性功能障碍之间存在关联；这两种情况都与年龄密切相关，且尚无研究能够排除年龄作为这种关系中的混杂因素。
使用经过文化和语言验证的标准问卷版本，在英国伯明翰、荷兰博克斯梅尔、法国欧塞尔和韩国首尔等地，评估LUTS的患病率（采用国际前列腺症状评分，即IPSS）和勃起功能障碍（ED）评分（采用奥利里性功能量表）。在每个中心，从人口登记册中选取分层随机样本，以提供各社区40 - 79岁男性（及其伴侣）人群的代表性样本。在首尔进行直接访谈，在三个欧洲中心使用邮寄问卷。样本随机选取，以在每个社区提供代表性样本。
共有4800名男性和3674名女性做出回应；男性的回应率在博克斯梅尔为77%，在欧塞尔为21%，在伯明翰为42%，在首尔为65%。40 - 79岁男性中，以ED评分为0 - 4来估计，ED的总体患病率为21.1%。有证据表明其随年龄呈线性增加（P < 0.001），且在四个中心的模式非常相似。从加权逻辑模型来看，有证据表明性功能障碍、其他自我报告的疾病和生活方式之间存在关联。从ED评分来看，在调整年龄和国家因素后，患有糖尿病的男性更有可能得0 - 4分（优势比1.57，95%置信区间1.09 - 2.25），患有高血压的男性也是如此（1.38，1.09 - 1.75），IPSS为8 - 35的男性同样如此（1.39，1.10 - 1.74）。对于生活方式，吸烟者更有可能得0 - 4分（1.54，1.23 - 1.92），而休闲时间进行体育活动与得0 - 4分的几率略有降低相关（0.87，0.77 - 0.99）。当使用自我报告的ED而非二分法评分重复分析时，得到了相同的结果。
ED显然与年龄相关，是社区中很大一部分男性面临的问题。它会对男性及其伴侣的生活质量产生深远影响。如果所有有此问题的男性都寻求医疗帮助，将给医疗系统带来巨大负担。在对这个问题的评估上存在文化和年龄方面的影响。
