Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperpla
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INVITED REVIEW
Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia Cosimo De Nunzio1 · Andrea Salonia2,3 · Mauro Gacci4 · Vincenzo Ficarra5 Received: 10 December 2019 / Accepted: 23 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To review the role of a persistent prostatic inflammatory status (PIS) in the development and progression of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) and which medical therapies approved for LUTS/BPH may reduce persistent PIS. Methods Literature search in PubMed up to July 2019. Results The cause of histologically defined persistent PIS or chronic prostatic inflammation is multifactorial. It is evident in many men with LUTS/BPH, particularly in older men and in men with a large prostate volume or more severe (storage) LUTS. Additionally, persistent PIS is associated with an increased risk of acute urinary retention and symptom worsening. Of medical therapies approved for LUTS/BPH, the current evidence for a reduction of persistent PIS is greatest for the hexanic extract of Serenoa repens (HESr). This treatment relieves LUTS to the same extent as α1-adrenoceptor antagonists and short-term 5α-reductase inhibitors. Limited evidence is available on the effect of other mainstream LUTS/BPH treatments on persistent PIS. Conclusions Persistent PIS plays a central role in both the development and progression of LUTS/BPH. In men with LUTS/ BPH who have a high chance of harbouring persistent PIS, HESr will not only improve LUTS, but also reduce (underlying) inflammation. Well-designed clinical studies, with a good level of evidence, are required to better evaluate the impact of BPH/LUTS medical therapies on persistent PIS. Keywords Prostatic hyperplasia · Prostatic inflammation · Progression · Medical therapy · Phytotherapy · Serenoa repens
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03106-1) contains supplementary material, which is available to authorized users. * Vincenzo Ficarra [email protected] 1
Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
2
University Vita-Salute San Raffaele, Milan, Italy
3
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
4
Minimally Invasive and Robotic Surgery, and Kidney Transplantation, University of Florence AOUC-Careggi Hospital, Florence, Italy
5
Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Piazza Pugliatti, 1, 98122 Messina, ME, Italy
Benign prostatic hyperplasia (BPH) is the most common, chronic, slowly progressing urological disease in elderly men, evident in 50% of men in their 50 s and in 90% in their 80 s [1]. Clinically, it can be associated with benign prostatic enlargement (BPE) and eventually benign prostatic obstruction (BPO), causing bladd
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