Urinary Symptoms Linked to Erectile Function in Congo Men

In a prospective, analytical cross-sectional study conducted in Brazzaville, Republic of the Congo, researchers identified a significant and independent association between lower urinary tract symptoms and erectile function in men aged over 40. The study, published in Discover Medicine, involved 337 sexually active men who participated in a health campaign at the Department of Urology-Andrology at Brazzaville University Hospital in November 2025. The findings indicate that as the severity of urinary symptoms increases, erectile function tends to decline, a relationship that persists even after adjusting for age and other major comorbidities. This research provides rare epidemiological data from sub-Saharan Africa, a region where evidence on the intersection of urological and sexual health remains limited.

The study aimed to quantify the linear relationship between lower urinary tract symptoms and erectile function, two conditions that are prevalent in men over 40 and significantly impair quality of life. While the co-occurrence of these conditions is well-documented in international literature, the specific dynamics in the Republic of the Congo had not been previously characterized. The researchers sought to determine whether the association was merely a byproduct of aging or if it represented a distinct clinical link. By using standardized assessment tools, the team was able to measure the strength and direction of this relationship across the entire spectrum of symptom severity, rather than comparing predefined categorical groups.

Participants were recruited consecutively during an open health campaign, with inclusion criteria requiring men to be over 40 years old, sexually active, and willing to provide informed consent. The study excluded individuals using medications that affect erectile function or those currently undergoing treatment for lower urinary tract symptoms. A total of 337 participants completed both the International Prostate Symptom Score and the five-item International Index of Erectile Function without missing data. The cohort had a mean age of 61 years, with the majority falling into the 60–69 age group, reflecting the demographic where bladder outlet obstruction becomes increasingly common.

Lower urinary tract symptoms were assessed using the International Prostate Symptom Score, a seven-question instrument that evaluates storage, voiding, and post-micturition symptoms on a scale from 0 to 35. Erectile function was measured using the International Index of Erectile Function, a five-item questionnaire with a maximum score of 25, where higher scores indicate better function. The study found that 93.8% of participants reported lower urinary tract symptoms, with the majority classified as mild or moderate. Weak stream was the most prevalent individual symptom, reported by 70.9% of the cohort, followed by nocturia at 68.5%. These findings align with global patterns where storage and voiding symptoms dominate in older male populations.

Erectile dysfunction was reported by 76.3% of the participants, a proportion consistent with the advanced age of the cohort. Most cases were classified as mild erectile dysfunction, with fewer instances of moderate or severe impairment. The mean International Prostate Symptom Score was 8.9, while the mean International Index of Erectile Function score was 16.1. The distribution of erectile dysfunction severity increased with the severity of urinary symptoms, suggesting a graded relationship between the two conditions. This pattern supports the hypothesis that the burden of urinary symptoms is not independent of sexual health in this demographic.

Statistical analysis revealed a moderate negative correlation between the International Prostate Symptom Score and the International Index of Erectile Function, with a Pearson correlation coefficient of -0.35. This negative association was also observed for individual symptom items, with correlation coefficients ranging from -0.32 to -0.20. To account for potential confounding factors, the researchers employed multivariate linear regression models. After adjusting for age, hypertension, history of sexually transmitted infections, physical activity, alcohol consumption, and prostate-specific antigen levels, the association remained significant. The adjusted standardized coefficient was -0.23, indicating that higher urinary symptom scores were independently associated with lower erectile function scores.

The regression model explained 29.4% of the variance in erectile function scores, highlighting the substantial role of urinary symptoms in this context. When the analysis was broken down by symptom type, storage and voiding symptoms were independently associated with erectile function, while post-micturition symptoms were not. The effect size of lower urinary tract symptoms was comparable to that of age in the adjusted model and greater than other included confounders. This suggests that, beyond the natural aging process, the presence of urinary symptoms may constitute a clinically relevant determinant of erectile health in men over 40.

The researchers proposed several pathophysiological mechanisms to explain this co-occurrence, including dysregulation of the nitric oxide pathway, which plays a central role in both erectile function and urinary sphincter regulation. Overexpression of the RhoA/Rho-kinase pathway and hyperactivity of the sympathetic nervous system were also cited as potential contributors. Chronic pelvic ischemia resulting from atherosclerosis was identified as another plausible mechanism, as it can adversely affect both bladder and penile tissues. These shared vascular and neurogenic mechanisms suggest a common underlying continuum that links urinary and sexual health in older men.

The study has several clinical implications, particularly for healthcare settings in the Republic of the Congo where local data are limited. The findings support the need for an integrated approach to patient care, where clinicians systematically screen for erectile dysfunction in men presenting with lower urinary tract symptoms, and vice versa. Such a strategy could optimize overall care and improve patients’ quality of life by addressing both conditions simultaneously. The results also reinforce the importance of awareness and training programs for healthcare professionals to improve the screening and joint management of these frequently associated conditions.

Limitations of the study include its cross-sectional design, which precludes causal inference, and the potential for bias from self-reported data. The recruitment of participants during a voluntary health campaign at a single center may limit the generalizability of the findings to other populations or settings. Additionally, the sample size was not large enough to permit comprehensive subgroup analyses, and unmeasured factors such as psychological variables and hormonal profiles could have influenced the results. Despite these limitations, the study provides valuable original data from a region with limited epidemiological evidence on this topic.

This research contributes to the growing body of evidence that lower urinary tract symptoms and erectile dysfunction are closely related conditions in men over 40. The significant and independent correlation observed in this cohort underscores the importance of considering both conditions in clinical practice. By identifying the strength of this association in Brazzaville, the study offers a foundation for future research and potential public health interventions in sub-Saharan Africa. The findings highlight the need for comprehensive patient management strategies that address the complex interplay between urological and sexual health.

The study was designed in accordance with the STROBE guidelines for observational studies, ensuring methodological rigor in the collection and analysis of data. The use of validated French-language versions of the assessment instruments helped ensure that participants comprehended the questions correctly, thereby enhancing the quality of the data collected. The researchers performed sensitivity analyses to test the robustness of their findings, which generally supported the main results. This thorough approach to statistical analysis strengthens the credibility of the observed association between urinary symptoms and erectile function.

As the population ages, the prevalence of both lower urinary tract symptoms and erectile dysfunction is expected to increase, making their association a growing public health challenge. Understanding the relationship between these conditions is crucial for developing effective screening strategies and improving overall patient care. The data from Brazzaville adds an important perspective to the global conversation, highlighting the need for localized research and tailored clinical guidelines. Future studies with larger sample sizes and longitudinal designs could further elucidate the causal mechanisms and long-term outcomes associated with this comorbidity.

Subject of Research: Association between lower urinary tract symptoms and erectile function in men over 40 in Brazzaville

Article Title: Relationship between lower urinary tract symptoms and erectile function in men aged over 40 years in Brazzaville, Republic of the Congo

Article References: Onguélé-Okemba, G., Dimi Nyanga, Y. I., Banga-Mouss, R. B., Ondziel Opara, S. A., Ekouya Oba, N. L., Odzébé, A. W. S., & Bouya, P. A. (2026). Relationship between lower urinary tract symptoms and erectile function in men aged over 40 years in Brazzaville, Republic of the Congo. Discover Medicine, 3(1), Article 122. https://doi.org/10.1007/s44337-026-00662-0

Image Credits: AI Generated

DOI: 10.1007/s44337-026-00662-0

Keywords: lower urinary tract symptoms, erectile dysfunction, cross-sectional study, Brazzaville, urology, men's health, epidemiology, sub-Saharan Africa, Relationship, between, lower, urinary