Microvascular dysfunction and efficacy of PDE5 inhibitors in BPH-LUTS

Selim Cellek, Norman E Cameron, Mary A Cotter, Christopher H Fry, Dapo Ilo

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) and erectile dysfunction commonly coexist, and both respond to phosphodiesterase (PDE) 5 inhibitors, suggesting a shared pathophysiological mechanism. We propose that both BPH-LUTS and erectile dysfunction are caused by microvascular dysfunction within the pelvic organs, and we present an overview of preclinical and clinical studies supporting the hypothesis that, within both the penis and the lower urinary tract, a combination of endothelial and neural dysfunction leads to a vicious cycle of hypoxia, vasoconstriction, altered smooth muscle contractility, and degeneration of autonomic neurons and ganglia. This hypothesis explains much of the preclinical and clinical research relating to these two conditions, and provides a rationale for further investigation into the effects of PDE5 inhibitors on the pathophysiology and symptoms of BPH-LUTS.

Original languageEnglish
Pages (from-to)231-241
Number of pages11
JournalNature reviews. Urology
Issue number4
Early online date11 Mar 2014
Publication statusPublished - Apr 2014


  • Erectile Dysfunction
  • Humans
  • Lower Urinary Tract Symptoms
  • Male
  • Microvessels
  • Phosphodiesterase 5 Inhibitors
  • Prostatic Hyperplasia
  • Vascular Diseases


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