UroToday - Dr. Kevin McVary (Chicago) presented the AUA lecture. The incidence of ED increases to over 60% by age 60. He showed data that ED increases with increasing severity of LUTS, independent of age. Across all age groups, increasing LUTS correlated with worse ED even after adjusting for other factors such as diabetes mellitus. This suggests a common pathophysiology or causal relationship between ED and LUTS.

In the MTOPS data, sexual function domains were stratified against AUA symptom indices and all sexual function domains correlated with LUTS. Prostate volume also correlated with ED as increasing size and worsening ED were linked. Several theories may explain these findings. Nitros oxide (NO) can be reduced by smoking, diabetes, etc. and result in prostatic hyperplasia that contributes to LUTS. In a canine prostate model, exposure to NO results in increased relaxation of smooth muscle, consistent with the hypothesis. Dr. McVary's research has shown decreased NO as men age. The enzyme PDE-5 in the prostate and bladder is increased and may contribute to ED. Experimental models of PDE-5 inhibitors result in increased smooth muscle relaxation.

He spoke about using the PDE-5 inhibitor concept to treat LUTS. A placebo run-in phase is important in LUTS trials. Sildenafil was tested in a combined ED/LUTS trial, and LUTS scores improved by over 6 points. Both obstructive and irritative scores improved. He cited Dr. Steif's vardinafil study that also demonstrated an improvement in LUTS. Despite symptom improvement, Dr. McVary did not find any improvement in urinary flow rate.

He also spoke about atherosclerosis induced chronic ischemia causing bladder and penile fibrosis and contributing to both voiding and erectile symptoms. Another theory is that increased autonomic activity correlates to ED and LUTS. He presented data in patients to support this correlation. A causal relationship was not demonstrated. Increased sympathetic tone from obesity, physical inactivity and other causes lead to effects on erectile function and LUTS.

Presented by: Kevin McVary, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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