Prostate Dimensions and Their Impact on LUTS and Erectile Function: Is Length the Missing Link?

<b>Background/Objectives</b>: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions-width, height, and length-and both LUTS and IIEF and to assess patients based on risk factors such as hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and PSA levels. <b>Methods</b>: A retrospective multicenter study was conducted between January 2007 and December 2023, focusing on male patients over the age of 40. The study evaluated hypertension, diabetes, cardiovascular diseases, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) through the completion of the IPSS and QoL questionnaires, sexual function using the IIEF-15, and PSA levels. Abdominal ultrasound was performed to determine prostate volume and its dimensions (width, height, and length). <b>Results</b>: A total of 943 patients were included in the study, with a mean age of 61.89 ± 8.51 years. From the 40-49 age group to the 80-90 age group, IPSS increased from 10.29 to 14.26 points, PSA from 1.1 ng/mL to 3.05 ng/mL, and prostate volume from 23.79 mL to 41.16 mL. Meanwhile, over the same age intervals, IIEF showed a decline from 52.57 to 24.76 points. The IPSS demonstrated a statistically significant positive correlation (<i>p</i> < 0.05) with prostate volume and patient age, while showing an inverse correlation with IIEF. The only statistically significant correlation between IPSS and prostate dimensions was with the length diameter of the prostate (<i>p</i> = 0.011). The severity of sexual symptoms was inversely correlated with both prostate volume and age. Additionally, IIEF was negatively correlated with the width and length diameters of the prostate. Hypertension (<i>p</i> = 0.57), diabetes (<i>p</i> = 0.57), smoking (<i>p</i> = 0.76), and alcohol consumption (<i>p</i> = 0.27) did not have a statistically significant impact on IPSS, and IIEF except for cardiovascular diseases, which showed a significant correlation with IPSS in patients experiencing moderate to severe symptoms (<i>p</i> = 0.0001). The statistically significant correlation between cardiovascular diseases and IIEF was observed only in patients with severe symptoms (<i>p</i> = 0.0001). <b>Conclusions</b>: There is a correlation between prostate volume, IPSS, and IIEF. Only length of the prostate shows a statistically significant correlation with both IPSS and IIEF. PSA levels increase progressively with each decade of age. Hypertension, diabetes, smoking, and alcohol consumption do not have a statistically significant impact on LUTS and erectile function. Cardiovascular diseases show a correlation with patients experiencing moderate to severe LUTS, as well as with those who have severe symptoms according to the IIEF evaluation.