EAU 2004 Conference Report on 'LUTS, BPH and ED – Is There Common Ground?'

During Day I (March 24, 2004) of The European Association of Urology offered of a State of the Art lecture presented by Karl-Erik Andersson, MD, PhD from the Department of Clinical and Experimental Pharmacology, Lund University Hospital, Lund Sweden titled "LUTS, BPH and ED - Is There Common Ground?"

Professor Andersson developed the hypothesis through a systematic assessment of postulated links between lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH), and erectile dysfunction (ED). According to the International Continence Society, LUTS can be divided into three groups, voiding, storage, and postmicturition symptoms. They are often, but not exclusively associated with the occurrence of BPH. LUTS are prevalent in aging men, and so is erectile dysfunction (ED).

Professor Andersson explored several hypothesis that have been proposed throughout the literature that link LUTS and ED including the predominance of the conditions to coexist in older men, the negative impact of LUTS on quality of life leading to erectile dysfunction and suggestions by others that the hyper-adrenergic state in the pelvis can be associated with LUTS and adversely impact upon erective dysfunction.

As a component of the literature review, Professor Andersson hypothesizes that BPH/LUTS and ED seem to share a hyperactivity of smooth muscle in their pathophysiology. In addition to this being attributed to increased sympathetic activity and increased stimulation of smooth muscle a-ARs, several other contractant transmitters other than noradrenaline may be involved, such as endothelins, angiotensins and prostanoids. The assessment of this hypothesis resulted in the conclusion: "That taken together, available information suggests that morphological changes in the prostate and bladder associated with LUTS, hypertension, and ED have a common mechanism - upregulation of the Rho-kinase activity in smooth muscle. This may lead to an increased sensitivity to calcium, and an increased response to contractile transmitters and mediators involved in the control of smooth muscle tone and in tissue changes within the prostate, lower urinary tract, penile erectile tissues, and in the vasculature. In turn this may be manifested in BPH/LUTS, hypertension and ED.

European Association of Urology

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