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Medical Management of Comorbid BPH/LUTS and ED: Defining the Current Treatment Algorithm

  • Authors: Culley C. Carson III, MD; Kevin T. McVary, MD
  • CME Released: 6/19/2012
  • Valid for credit through: 6/19/2013
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Target Audience and Goal Statement

This activity has been designed to meet the educational needs of primary care physicians and urologists interested in the diagnosis and management of BPH/LUTS and ED.

Numerous epidemiologic studies have reported a strong association between benign prostatic hyperplasia–associated lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED) that is independent of age and other comorbidities.

LUTS and ED share common elements, including a multifactorial etiology and a possible biological link. Although a direct causal relationship is not yet established and the pathogenesis has not been completely elucidated, 4 pathophysiologic mechanisms potentially explain the relationship: an alteration in nitric oxide bioavailability, α1-adrenergic receptor hyperactivity, pelvic atherosclerosis, and sex hormones. These pathophysiologic pathways have various clinical implications for the management of ED and LUTS. Clinicians should recognize that all men seeking care for ED should be screened for complaints of BPH/LUTS and vice versa. Furthermore, sexual function should be assessed and discussed with the patient when choosing the appropriate management strategy for BPH/LUTS as well as when evaluating the patient's response to treatment.

Clinicians need to be aware of the potential positive and negative effects on sexual function of all medical therapies for BPH/LUTS. No single therapy for BPH/LUTS is superior to another; physicians should consider individual patient factors, efficacy, tolerability, treatment-related AEs (eg, retrograde ejaculation, diminished libido, ED), cost, and patient preference. Furthermore, men seeking help for BPH/LUTS should be assessed for various aspects of sexual dysfunction and informed about the impact of medication and surgery on sexual health.

Upon completion of this activity, participants should be able to:

  1. Screen all men seeking care for benign prostatic hyperplasia–associated lower urinary tract symptoms (BPH/LUTS) for erectile dysfunction (ED) and vice versa
  2. Examine with patients the adverse effect (AE) profile of each therapy when deciding the appropriate management strategy for BPH/LUTS and evaluating the patient's treatment response
  3. Select therapeutic modalities with minimal AEs, particularly sexual AEs
  4. Integrate BPH/LUTS and ED treatment goals to improve quality of life and optimize health outcomes


It is the policy of the Annenberg Center to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All faculty and planners participating in sponsored programs are expected to identify and reference off-label product use and disclose any significant relationships with those supporting the activity or any others whose products or services are discussed.

The ideas and opinions presented in this educational activity are those of the faculty and do not necessarily reflect the views of the Annenberg Center and/or its agents. As in all educational activities, we encourage the practitioners to use their own judgment in treating and addressing the needs of each individual patient, taking into account that patient's unique clinical situation. The Annenberg Center disclaims all liability and cannot be held responsible for any problems that may arise from participating in this activity or following treatment recommendations presented.

This activity will address professional practice gaps in knowledge.

This program will contain discussion of investigational uses of pharmacologic and nonpharmacologic therapies. Individual clinical judgments should be used in all patient care decisions.

In accordance with the Accreditation Council for Continuing Medical Education standards, parallel documents from other accrediting bodies, and Annenberg Center policy, the following disclosures have been made:

All staff at the Annenberg Center for Health Sciences at Eisenhower have nothing to disclose.

All staff at CogniMed Inc. have nothing to disclose.


  • Culley C. Carson III, MD

    Rhodes Distinguished Professor and Chief of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina


    Disclosure: Grant/Research Support, Consultant, and/or Speakers' Bureau: American Medical Systems; Auxilium Pharmaceuticals, Inc.; Eli Lilly and Company; GlaxoSmithKline

  • Kevin T. McVary, MD

    Professor of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois


    Disclosure: Grant/Research Support, Consultant, and/or Speakers' Bureau: Allergan, Inc.; Eli Lilly and Company; GlaxoSmithKline; the National Cancer Institute; the National Institutes of Health; Watson Pharmaceuticals, Inc.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Annenberg Center for Health Sciences at Eisenhower and CogniMed Inc. The Annenberg Center is accredited by the ACCME to provide continuing medical education for physicians.

    Statements of Credit will be provided electronically following activity participation and upon completion and submission of the evaluation online.

    The Annenberg Center for Health Sciences at Eisenhower designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians claim only the credit commensurate with the extent of their participation in the activity.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. The estimated time to complete this activity is 1.5 hours; physicians should claim only those credits that reflect the time actually spent in the activity. This activity is an enduring material and consists of 3 interactive case studies. Successful completion is achieved by viewing the material, reflecting on its implications in your practice, and completing the assessment component. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


Medical Management of Comorbid BPH/LUTS and ED: Defining the Current Treatment Algorithm

Authors: Culley C. Carson III, MD; Kevin T. McVary, MDFaculty and Disclosures

CME Released: 6/19/2012

Valid for credit through: 6/19/2013


This program was developed to be released on Medscape.

The questions in this test-and-teach educational program are designed to test your current knowledge. After each question, you will see whether you answered the question correctly. The authors present referenced information to support the most appropriate answer choice and supplemental information (accessible by clicking on the links) to provide a more thorough understanding of the topic and the answers.
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