You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



Benign Prostatic Hyperplasia–Lower Urinary Tract Symptoms: Improved Long-term Care of Patients With Erectile Dysfunction

  • Authors: Martin M. Miner, MD, Chair; Matt T. Rosenberg, MD; David R. Staskin, MD
  • CME Released: 9/17/2012
  • Valid for credit through: 9/17/2013
Start Activity

Target Audience and Goal Statement

This activity was developed for urologists, primary care physicians (PCPs), and related healthcare providers who assess and manage patients with BPH-LUTS and commonly co-occurring disorders, particularly erectile dysfunction.

Benign prostatic hyperplasia (BPH) is a pathologic diagnosis characterized primarily by proliferation of prostatic stromal and epithelial cells. When BPH is associated with lower urinary tract symptoms (LUTS; eg, urinary frequency, hesitancy, and intermittency; incomplete voiding; weak urine stream; nocturia; and urgency), BPH-LUTS becomes a clinical diagnosis.1 Highly prevalent and often underdiagnosed, BPH-LUTS is a chronic and progressive condition that greatly increases functional impairment, diminishes quality of life, and interferes with sexual function and other aspects of daily living.1-4 Further, patients with BPH-LUTS often have co-occurring conditions, including ED (BPH-LUTS+ED) in particular, as well as metabolic syndrome, cardiovascular abnormalities, and other morbidities that may challenge the management of this patient population.3,5-7

Multidimensional assessment of BPH-LUTS±ED is critical to recognition of the condition and is predicated primarily on a thorough patient evaluation that includes a focused history, physical exam, and minimal laboratory tests. At times, referral to a specialist is warranted, although many patients can be managed sufficiently in the primary care setting. As it largely guides treatment of patients with BPH-LUTS±ED, information about symptom severity and the degree of bother are critical to optimal therapy and patient outcomes. While watchful waiting is often used for patients with minimal symptoms and bother, Level 1 evidence supports currently available monotherapy and multidrug regimens to ameliorate urinary symptoms and slow disease progression in patients whose symptoms are more severe.8-10 As BPH-LUTS is a progressive condition, ongoing monitoring is warranted in this patient population. This educational activity is designed to enhance the clinician's understanding of the complex, interrelated nature of BPH-LUTS±ED, and best practices for initial and ongoing management.

1. Roehrborn CG. Int J Impot Res. 2008;20(suppl 3):S11-S18.
2. DeCastro J, Stone B. Am J Med. 2008;121(8 suppl 2):S27-S33.
3. McVary KT. BJU Int. 2006;97(suppl 2):S23-S28.
4. Rosenberg MT, et al. Int J Clin Pract. 2010;64:488-496.
5. Gacci M, et al. Eur Urol. 2011;60:809-825.
6. Johnson TV, et al. Urology. 2010;76:1317-1320.
7. McVary KT, et al. J Urol. 2011;185:1793-1803.
8. Greco KA, McVary KT. Int J Impot Res. 2008;20(suppl 3):S33-S43.
9. Hollingsworth JM, et al. J Urol. 2009;182:2410-2414.
10. McConnell JD, et al. N Engl J Med. 2003;349:2387-2398.

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

  1. Conduct an initial and ongoing assessment of patients with benign prostatic hyperplasia (BPH), addressing lower urinary tract symptoms (LUTS), coexisting disorders, patient quality of life, and function.
  2. Evaluate the risk of BPH disease progression and complications.
  3. Teach patients with BPH-LUTS practical self-management approaches and behavioral modifications to slow disease progression.
  4. Evaluate the clinical profiles and utility of 5-alpha-reductase inhibitors, alpha-1 adrenergic receptor blockers, and phosphodiesterase-5 (PDE-5) inhibitors for patients with BPH-LUTS with and without erectile dysfunction (BPH-LUTS±ED).
  5. Tailor monotherapy and multidrug regimens for patients with BPH-LUTS based in part on signs and symptoms, prior medication history, ED and other common comorbidities, risk of disease progression, and patient goals.


All faculty and staff involved in the planning or presentation of continuing education activities sponsored/provided by Purdue University College of Pharmacy are required to disclose to the audience any real or apparent commercial financial affiliations related to the content of the presentation or enduring material. Full disclosure of all commercial relationships must be made in writing to the audience prior to the activity.


  • Martin M. Miner, MD, FAAFP, Chair

    Clinical Associate Professor of Family Medicine and Urology, The Warren Alpert Medical School of Brown University, Co-Director, Men's Health Center, Chief of Family Community Medicine, Miriam Hospital, Providence, Rhode Island


    Disclosure: Auxilium Pharmaceuticals Inc. (Consultant); GlaxoSmithKline (Grants/Research Support); Lilly USA LLC (Consultant).

  • Matt T. Rosenberg, MD

    Medical Director, Mid-Michigan Health Centers, Chief, Department of Family Medicine, Foote Health System, Jackson, Michigan


    Disclosure: Astellas Pharma US Inc. (Consultant/Speakers Bureau); Eli Lilly and Company (Consultant); Ferring Pharmaceuticals Inc. (Consultant); Forest Laboratories Inc. (Speakers Bureau); Horizon Pharma (Consultant/Speakers Bureau); Ortho-McNeil-Janssen Pharmaceuticals Inc (Speakers Bureau); Pfizer Inc. (Consultant/Speakers Bureau).

  • David R. Staskin, MD

    Associate Professor of Urology, Tufts University School of Medicine, Steward–St. Elizabeth's Medical Center, Boston, Massachusetts


    Disclosure: Allergan Inc. (Consultant, Speakers Bureau); AltheRx Pharmaceuticals (Consultant); Astellas Pharma US Inc. (Consultant, Speakers Bureau); Takeda Pharmaceutical Company Limited (Consultant); Watson Pharmaceuticals Inc. (Speakers Bureau).

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 Purdue University College of Pharmacy and Asante Communications LLC. Purdue University College of Pharmacy, an equal access/equal opportunity institution, is accredited by the ACCME to provide continuing medical education for physicians.

    This CME activity is structured around consensus statements developed by a working group of experts with particular expertise in the multidimensional care of benign prostatic hyperplasia-lower urinary tract symptoms (BPH-LUTS) patients with or without erectile dysfunction (ED). Using a modified Delphi process, the BPH-LUTS Working Group has consolidated published evidence and expert clinical experience on critical issues pertaining to the phenomenology of BPH-LUTS±ED, assessment and diagnosis, treatment, ongoing management, and interdisciplinary care. Findings from the Delphi process informed the topics highlighted in this video roundtable CME activity.

    Purdue University College of Pharmacy designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Contact this provider

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.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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.


Benign Prostatic Hyperplasia–Lower Urinary Tract Symptoms: Improved Long-term Care of Patients With Erectile Dysfunction

Authors: Martin M. Miner, MD, Chair; Matt T. Rosenberg, MD; David R. Staskin, MDFaculty and Disclosures

CME Released: 9/17/2012

Valid for credit through: 9/17/2013


  • Print