Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms Pathophysiology to Improved Patient Care

Steven A. Kaplan, MD-Prerecorded, Kevin T. McVary, MD, FACS, David R. Staskin, MD

Jointly sponsored by Educational Review Systems, Inc., and Integritas Communications.

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit

Educational Objectives

At the conclusion of this educational activity, participants should be better prepared to:

  • Describe the pathophysiology of benign prostatic hyperplasia and lower urinary tract symptoms (BPH-LUTS) and relationships with common comorbidities
  • Assess patients with BPH-LUTS for symptom severity, risk of disease progression, comorbidities, and deleterious effects on function and quality of life
  • Evaluate the mechanisms of action and clinical profiles of α1-adrenergic receptor blockers, 5α-reductase inhibitors, and phosphodiesterase-5 inhibitors in the treatment of BPH-LUTS with and without erectile dysfunction
  • Prescribe pharmacologic regimens in combination with behavioral modifications for BPH-LUTS to reflect signs and symptoms, common comorbidities, risk of disease progression, and patient goals
  • Monitor treatment efficacy and adherence in patients with BPH-LUTS to guide therapeutic restructuring and optimize patient outcomes

Needs Assessment and Learner’s Gap

Associated with age-related benign prostatic enlargement, BPH can cause bladder outlet obstruction, which in turn can reduce or otherwise prevent urine flow. In addition to age, underlying factors that contribute to BPH include hypertension, diabetes, dyslipidemia, obesity, and smoking. These factors result in elevated autonomic nerve activity that stimulates prostate growth and endothelial smooth muscle contraction, which together present as LUTS.1 One recent study of LUTS in individuals with BPH found that 56% of men between 50 and 79 years of age, and 70% of men 80 years or older experience LUTS.2 These epidemiologic data depict a prevalent and burdensome disorder that adversely affects patient quality of life and function, particularly in men older than 50 years.3,4

Urologists are critical to improving care and optimizing outcomes for patients with BPH-LUTS.5 Gaps in evidence-based guidelines, however, can leave urologists unsure of how to proceed in many clinical situations. This Interactive Exchange™ program will review the pathophysiologic underpinnings of BPH-LUTS, the relationships between BPH-LUTS and erectile dysfunction or cardiometabolic disturbances, and the mechanistic rationale for various pharmacologic agents that target disease processes.6-9 Evidence-based recommendations for symptom evaluation, comprehensive patient-centered approaches to treatment, and management considerations for complex cases will also be central to this interactive discussion.7,8

Intended Audience

This activity is intended for urologists, primary care providers, nurse practitioners, physician assistants, and other health care providers involved in the diagnosis and ongoing management of BPH and associated LUTS.

There are no prerequisites for this educational activity.


  1. McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int. 2006;97 (suppl 2):23-28.
  2. Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology. 2008;72:318-321.
  3. Emberton M, Marberger M, de la Rosette J. Understanding patient and physician perceptions of benign prostatic hyperplasia in Europe: The Prostate Research on Behaviour and Education (PROBE) Survey. Int J Clin Pract. 2008;62:18-26.
  4. Rosenberg MT, Staskin DR, Kaplan SA, et al. A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting. Int J Clin Pract. 2007;61:1535-1546.
  5. Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am. 2011;95:87-100.
  6. Gacci M, Eardley I, Giuliano F, et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2011;60(4):809-825.
  7. Gacci M, Corona G, Salvi M, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2012;61:994-1003.
  8. McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793-1803.
  9. Abdollah F, Briganti A, Suardi N, et al. Metabolic syndrome and benign prostatic hyperplasia: evidence of a potential relationship, hypothesized etiology, and prevention. Korean J Urol. 2011;52(8):507-516.

Accreditation Statement

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 Educational Review Systems, Inc., and Integritas Communications.

Credit Designation

This program has been reviewed and is acceptable for up to 1.0 Prescribed credit hours by The American Academy of Family Physicians.  AAFP Prescribed credit is accepted by The AMA as equivalent to AMA PRA Category I for the American Medical Association (AMA) The Physician’s Recognition Award (PRA). When applying for the AMA PRA,  Prescribed hours earned must be reported as Prescribed hours, not as Category I. (This statement applies to all Physicians, not just Family Physicians).

Conflict of Interest Statement

The Conflict of Interest Disclosure Policy of Educational Review Systems, Inc., requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to his/her contribution to the activity will not be permitted to present.

Educational Review Systems, Inc., also requires that faculty participating in any CME activity and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.

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expiration 02/08/2014

type Webcast