Greater prostate zonal volume in patients with benign prostatic hyperplasia is associated with an increased likelihood of erectile dysfunction (ED), a new study found.

Investigators at Suez Canal University in Ismailia, Egypt, found significant correlations between increased transitional zone volume (TZV), transitional zone index (TZI) and both the International Index of Erectile Function (IIEF) and penile peak systolic velocity (PSV).

The study included 70 men, of whom 60 were assigned to 1 of 3 study groups (20 each). Group A included men who had lower urinary tract symptoms (LUTS) and ED; group B included men who had LUTS with no ED; and group C included men who had ED but no LUTS. The other 10 men made up a control group (group D) of age-matched patients with no ED or LUTS. The investigators assessed ED using the International Prostate Symptom Score (IPSS) and IIEF questionnaires. They used Doppler ultrasonography to assess zonal anatomy and vascular patterns of erection.

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Groups A and C had a significantly lower PSV than groups B and D, a team led by Ahmed I. El-Sakka, MD, reported in Sexual Medicine. They found a significant positive correlation between TZI and IPSS and a significant negative correlation between TZI and both IIEF and PSV.

The median total prostate volume was 41.5, 37.6, 23.5, and 20.5 mL in groups A, B, C, and D, respectively. The median peripheral zonal volume (PZV) was 8, 10, 14, and 16 mL, respectively. The median TZV was 20.2, 16.7, 8, and 5 mL. The median TZI was 48.6%, 44.4%, 34%, and 25%. The median IPSS was 26, 19, 0, and 0. The mean IIEF was 10, 26, 15, and 28.

Groups C and D had a significantly higher PZV than groups A and B. Groups A and B had a significantly higher TZV than groups C and D. Groups C and D had a significantly lower TZI and central zonal volume than groups A and B.


Qalawena MM, Al-Shatouri MA, Motawaa MA, El-Sakka AI. Association between prostate zonal volume in patients with benign prostatic hyperplasia [published online March 5, 2020]. Sexual Med.   doi: 10.1016/j.esxm.2020.01.008