Echinacoside attenuates glandular fibrosis in benign prostatic hyperplasia via inhibiting MKK6/MK2 signaling pathway

Background:Lower urinary tract symptoms commonly occur in the elderly population and seriously constrain the quality of life.Glandular fibrosis is an important pathobiological process in benign prostatic hyperplasia and is also a main inducing factor for benign prostatic hyperplasia-associated lower urinary tract symptoms.Cistanches species is an important herbal medicine resource and is traditionally used in ameliorating renal and prostatic defects.Methods:This study was to investigate the potential protective function of echinacoside(a bioactive compound from Cistanches)against prostatic fibrosis in mice and human benign prostatic hyperplasia epithelial-1 cell models.Results:It was found that echinacoside attenuated testosterone-induced prostatic hyperplasia and collagen deposition in mice,relieved prostate local inflammation and oxidative damage,and ameliorated prostatic epithelial-mesenchymal transition.Additionally,echinacoside inhibited the activation of the MKK6/MK2 signaling pathway both in vivo and in vitro.Conclusion:This study added new evidence for the anti-fibrotic function of echinacoside on the prostate and provided new insights for understanding its possible pharmacological mechanisms.

Alleviatory effect of isoquercetin on benign prostatic hyperplasia via IGF-1/PI3K/Akt/mTOR pathway

We evaluated the effect of isoquercetin(quercetin-O-3-glucoside-quercetin,IQ)as a functional component of Abeliophyllum disistichum Nakai ethanol extract(ADLE)on prostate cell proliferation and apoptosis and its effects on the IGF-1/PI3K/Akt/mTOR pathway in benign prostatic hyperplasia(BPH).Metabolites in ADLE were analyzed using UHPLC-qTOF-MS and HPLC.IQ was orally administered(1 or 10 mg/kg)to a testosterone propionate-induced BPH rat model,and its effects on the prostate weight were evaluated.The effect of IQ on androgen receptor(AR)signaling was analyzed in LNCaP cells.Whether IGF-1 and IQ affect the IGF-1/PI3K/Akt/mTOR pathway in BPH-1 cells was also examined.The metabolites in ADLE were identified and quantified,which confirmed that ADLE contained abundant IQ(20.88 mg/g).IQ significantly reduced the prostate size in a concentration-dependent manner in a BPH rat model,and significantly decreased the expression of AR signaling factors in the rat prostate tissue and LNCaP cells in a concentration-dependent manner.IQ also inhibited the PI3K/AKT/mTOR pathway activated by IGF-1 treatment in BPH-1 cells.In BPH-1 cells,IQ led to G0/G1 arrest and suppressed the expression of proliferation factors while inducing apoptosis.Thus,IQ shows potential for use as a pharmaceutical and nutraceutical for BPH.

Volume of residual urine as an indication for surgical treatment of benign prostatic hyperplasia

Objective To study the volume of residual urine as related to the surgical indication for BPH. Methods Urodynamic study was carried out in 103 BPH patients who were assigned to group A(no residual urine), group B( residual urine【 60 ml) and group C( residual urine 60 - 100 ml). Results Qmax, URA, DR and DI were not significantly different between group C and group B (P 】 0.05) but significantly different between group C and A or between B and A(P【0.05). Conclusion The conventional conception that surgical intervention is indicated when the residual urine being 】 60 ml should be strictly followed. Early surgical intervention should be undertaken if the bladder outlet obstruction or bladder function deteriorated by BPH causing residual urine. Other causes such as neurogenic should be ruled out before surgery. 10 refs,2 tabs.

The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature

Objective:Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia(BPH).Methods:A retrospective analysis was performed for all patients who underwent 180 W XPSlaser photoselective vaporization of the prostate(PVP)vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers.Data collection included baseline comorbidities,disease-specific quality of life scores,maximum urinary flow rate(Qmax),postvoid residual(PVR),complications,prostate volume and prostate-specific antigen(PSA).The secondary endpoints were the incidence of intraoperative and postoperative adverse events.Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery.Results:Mean age of men was 67.8 years old,with a mean body mass index of 29.7 kg/m2.Mean prostate volume as measured by transrectal ultrasound was 29 mL.Anticoagulation use was 47%and urinary retention with catheter at time of surgery was 17%.Mean hospital stay and catheter time were 0.5 days.Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months(interquartile range,3-22.5 months).The International Prostate Symptom Score improved from 22.8±7.0 at baseline to 10.7±7.4(p<0.01)and 6.3±4.4(p<0.01)at 1 and 6 months,respectively.The Qmax improved from 7.70±4.46 mL/s at baseline to 17.25±9.30 mL/s(p<0.01)and 19.14±7.19 mL/s(p<0.001)at 1 and 6 months,respectively,while the PVR improved from 216.0±271.0 mL preoperatively to 32.8±45.3 mL(p<0.01)and 26.2±46.0 mL(p<0.01)at 1 and 6 months,respectively.The PSA dropped from 1.97±1.76 ng/mL preoperatively to 0.71±0.61 ng/mL(p<0.01)and 0.74±0.63 ng/mL at 1 and 6 months,respectively.No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively.Conclusion:The 180 W GreenLight XPS system is safe and effective for men with small volume BPH.PVP produced improvements in symptomatic and clinical parameters without any safety concern.It represents a safe surgical option in this under studied population.

Nitric oxide synthase 2 gene polymorphisms are associated with prostatic volume in Korean men with benign prostatic hyperplasia

The precise aetiology of benign prostatic hyperplasia （BPH） remains unclear; however, it is known that immunological inflammatory processes have a role in the pathogenesis of BPH initiation and progression. Nitric oxide synthase 2 （NOS2） inducible expression is closely correlated with prostatic disease, including prostate cancer and BPH. The aim of this study was to investigate the relationship between NOS2 polymorphisms and BPH. With a cohort of 205 controls and 229 BPH subjects, we genotyped three single nucleotide polymorphisms （SNPs） in the NOS2 gene, including rs2779248 （promoter, -278 T/C）, rs 10459953 （5＇-untranslated region） and rs2297518 （exon 16, missense, Ser608Leu）, using direct sequencing and restriction fragment length polymorphism. The genotypic and allelic frequencies between control and BPH subjects were compared, and the associations among the BPH subjects were analyzed. SNPStats, SNPAnalyzer and HelixTree programmes were used to analyze SNPs. There was no association on SNPs between control and BPH subjects. When BPH subjects were analyzed, there was no association on SNPs between the low and high prostate-specific antigen groups. However, one SNP （rs 10459953, odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.29-0.65, P 〈 0.0001, in codominant model; OR = 0.23, 95% CI = 0.12-0.46, P 〈 0.0001, in dominant model; and OR = 0.46, 95% CI = 0.24-0.86, P = 0.015, in recessive model） was associated with prostatic volume in BPH. We detected a strong association in genotype frequencies of NOS2 SNP （rs10459953） between subjects with small and large prostatic volume in BPH. The result suggests that NOS2 may be associated with prostatic volume in BPH.

Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients

Objective:Benign prostatic hyperplasia(BPH)is one of the most common diseases found among elderly men.Even though multiple risk factors of BPH have been identified in the past,the risk factors which have a direct impact on prostate volume have not been identified.In this study,we aim to determine the most significant contributing risk factors to prostate volume enlargement by analyzing possible associated risk factors previously studied.Methods:This is a quantitative study with an analytical observational design,performed using a retrospective cohort approach.Total sampling was performed on 83 patients who underwent transurethral resection of the prostate(TURP)in Sanglah General Hospital from January to February 2019.Bivariate analysis is performed to examine each variable's association with prostate volume followed by a multivariate analysis.All variables were reassessed with path analysis to measure the direct effects,indirect effects,and total effects on prostate volume.Results:Bivariate analysis shows that serum testosterone(R=0.208;p=0.059)and prostate-specific antigen(PSA)level(R=0.626;p=0.001)have a significant association with prostate volume.Multivariate analysis shows that serum PSA(B=1.4;p=0.001;95%confidence interval[95%CI]=1.039-1.770)and testosterone(B=0.024;p=0.005;95%CI=0.008-0.041)levels are significant among all the analyzed risk factors.There is a significant and strong effect of PSA to prostate volume(c=0.636;p=0.001)whereas testosterone has a significant albeit weak effect to prostate volume(c=0.246;p=0.009)based on the total effect of the path analysis.Conclusion:Serum testosterone and PSA levels are significantly associated with prostatic volume increase among BPH patients.

Prostate artery embolization for the treatment of urinary retention caused by large(>80 mL) benign prostatic hyperplasia: Results of 21 patients

Objective:A large prostate size(>80 m L)of benign prostatic hyperplasia(BPH)is technically challenging to treat surgically.This study aimed to investigate the safety and efficacy of super-selective prostatic artery embolization(PAE)for the treatment of urinary retention caused by large BPH.Methods:A total of 21 patients with urinary retention,indwelling urinary catheter,or suprapubic cystostomy as a consequence of giant BPH(prostate volume[PV]>80 mL)who sought treatment between January 2013 and December 2017 were enrolled.A microcatheter(1.9–2.7 Fr)and a"two-step embolization"combining 50-μm and100-μm polyvinyl alcohol embolization particles were used in all patients.International Prostate Symptom Score(IPSS),quality of life(QoL),PV,and prostate-specific antigen(PSA)were evaluated at 3,6,and 12 months postPAE.Clinical success was defined as removal of urinary catheter or suprapubic cystostomy and ability to void spontaneously.Results:The clinical success rate was 95.2%(20/21).Compared with pre-procedural values,IPSS,QoL,PV,and PSA showed statistically significant differences at 3,6,and 12 months post-PAE(P<0.05).There were no serious complications after PAE.Conclusions:PAE was safe and effective for the treatment of urinary retention caused by large BPH in patients without surgical treatment options.

Intravesical Prostate Protrusion (IPP) versus Middle Lobe Volume on Ultrasonography in Assessing the Impact of Benign Prostatic Hyperplasia

Background: Ultrasound is the main method of exploring the prostate. In benign prostatic hyperplasia (BPH), it provides important morphological information and assesses its impact, helping to guide the treatment. Objective: To compare intravesical prostatic protrusion (IPP) and middle lobe volume by ultrasound in BPH. Method: This was a single center prospective, descriptive and analytical study, over a period of 6 months, including 95 patients, undergoing prostatic trans-abdominal ultrasound. Patients were selected by a single urologist for clinical suspicion of benign prostatic hypertrophy. The ultrasound examination was done by a single senior radiologist. Results: The mean age of the patients was 66.63 ± 11.55 years with ranges from 38 to 98 years. The prevalence of BPH was 76.84%. The rate of patient with middle lobe protrusion was 48.42%. The mean middle lobe volume was 11.29 ± 12.90 ml. More than half of the patients (50.91%) had an IPP stage 3 of. The mean bladder wall thickness was 6.08 ± 2.58 mm, with 50.53% being pathological. The post-voiding residue (PVR) was significant in 38.75% of patients. Renal repercussions were present in 17.89%. The correlation analysis did not note a statistical link between prostate volume and quality of life score (p > 0.05). There was a statistically significant correlation between IPP values and quality of life score (p = 00461), IPSS score (p = 0.0424) and PVR (p = 0.0395). For middle lobe volume, there was a correlation with PVR (p = 0.0018). There was no correlation with clinical impact (quality of life score and IPSS score). Conclusion: The IPP appears to be an easy element to measure and better than the volume of the prostate and the middle lobe in assessing the impact of BPH.

Pathophysiology of clinical benign prostatic hyperplasia

A disease can be defined as an abnormal anatomy(pathology)and/or function(physiology)that may cause harm to the body.In clinical benign prostatic hyperplasis(BPH),the abnormal anatomy is prostate adenoma/adenomata,resulting in a varying degree of benign prostatic obstruction(BPO)that may cause harm to the bladder or kidneys.Thus clinical BPH can be defined as such and be differentiated from other less common causes of male lower urinary tract symptoms.Diagnosis of the prostate adenoma/adenomata(PA)can be made by measuring the intravesical prostatic protrusion(IPP)and prostate volume(PV)with non-invasive transabdominal ultrasound(TAUS)in the clinic.The PA can then be graded(phenotyped)according to IPP and PV.Multiple studies have shown a good correlation between IPP/PV and BPO,and therefore progression of the disease.The severity of the disease clinical BPH can be classified into stages from stage Ⅰ to Ⅳ for further management.The classification is based on the effect of BPO on bladder functions,namely that of emptying,normal if postvoid residual urine(PVRU)<100 mL;and bladder storage,normal if maximum voided volume(MVV)>100 mL.The effect of BPO on quality of life(QoL)can be assessed by the QoL index,with a score≥3 considered bothersome.Patients with no significant obstruction and no bothersome symptoms would be stage Ⅰ;those with no significant obstruction but has bothersome symptoms(QoL≥3)would be stage Ⅱ;those with significant obstruction(PVRU>100 mL;or MVV<100 mL),irrespective of symptoms would be stage Ⅲ;those with complications of the disease clinical BPH such as retention of urine,bladder stones,recurrent bleeding or infections would be stage Ⅳ.After assessment,further management can then be individualised.A low grade and stage disease can generally be watched(active surveillance)while a high grade and stage disease would need more invasive management with an option for surgery.The final decision making would take into account the patient’s age,co-morbidity,social economic background and his preferences/values. Proper understanding of pathophysiology of clinical BPH would lead to better selection of patients for individualised and personalised care andmore cost effective management.

Association of Increased Urine Brain Derived Neurotrophic Factor with Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia

Urinary brain-derived neurotrophic factor（BDNF）, an ubiquitous neurotrophin, was found to rise in patients with benign prostatic hyperplasia（BPH）. We hypothesized that the urinary level of BDNF could be a potential biomarker for lower urinary tract symptoms（LUTS） in patients with BPH. Totally, 76 patients with BPH-caused LUTS and 32 male control subjects without BPH were enrolled. International Prostate Symptom Score（IPSS） was applied to assess the symptom severity of LUTS. Urodynamic tests were performed for the diagnosis of underlying detrusor overactivity（DO） in the patients with BPH. Urine samples were collected from all subjects. Urinary BDNF levels were measured using enzyme-linked immunosorbent assays and normalized by urinary creatinine（Cr） levels. Seventy-six BPH patients were divided into moderate LUTS group（n=51, 720） according to the IPSS. Of the 76 BPH patients, DO was present in 34（44.7%） according to the urodynamic test. The urinary BDNF/Cr levels were significantly higher in BPH patients with moderate LUTS（8.29±3.635, P〈0.0001） and severe LUTS（11.8±6.44, P〈0.0001） than normal controls（1.71±0.555）. Patients with severe LUTS tended to have higher urinary BDNF/Cr levels than patients with moderate LUTS（11.8±6.44 vs. 8.29±3.635, P=0.000）. The conditions of BPH with LUTS correlated with elevated urinary BDNF levels, and urinary BDNF levels were even higher in BPH-DO patients. The results of this study have provided evidence to suggest that urinary BDNF level test could evaluate the severity of LUTS in BPH patients, and BDNF level can be used as a biomarker

Transurethral dividing vaporesection for the treatment of large volume benign prostatic hyperplasia using 2 micron continuous wave laser

Background The safety and efficiency of transurethral laser resection of the prostate to treat benign prostatic hyperplasia have been verified. However, this method does still not manage large volume prostates efficiently. To tackle this problem, we have designed a method of ＂transurethral dividing vaporesection of prostate＂ using a 2 micron continuous wave laser. The aim of this study was to evaluate the safety and efficiency of this method in the management of large prostates （〉80 ml）.Methods In this study, 45 cases of benign prostatic hyperplasia with a median prostatic volume of （123.7±26.7） ml （range, 80.2-159.8 ml） were treated by the same surgeon under epidural anesthesia. During the surgery, superapubic catheters were needed, and saline solution was used for irrigation. First, the prostate was divided longitudinally into several parts from the bladder neck to the prostatic apex, and then gradually incised transversely chip by chip. Intraoperative blood transfusion rate, postoperative complications, maximum urinary flow rate, International Prostate Symptom Score and quality of life scores were recorded for statistical analysis using SPSS 16.0 software.Results Intraoperatively, no transurethral resection syndrome was observed, and no blood transfusions were needed.The resected prostatic chips were easily flushed out of the bladder through the resectoscope sheath without the use of a morcellator. Median vaporesection time was （95.0±13.2） minutes （range, 75-120 minutes）, and the median retrieved and removed prostatic tissue were （25.2±5.1） g （range, 15.5-34.7 g） and （75.4±16.4） g （range, 43.8-106.1 g）, respectively. Median catheter time and hospital stay were （3.3±0.9） days （range, 3-5 days） and （4.8±1.8） days （range, 3-9 days）, respectively. After a follow-up of 6 to 12 months, two patients had stress urinary incontinence and three had anterior urethral strictures. Satisfactory improvement was seen in maximum urinary flow rate, International Prostate Symptom Score and quality of life scores.Conclusions This study showed that 2 micron laser vaporesection is a safe treatment for benign prostatic hyperplasia patients with large prostates, and the method of ＂dividing vaporesection＂ may help improve both surgical efficiency and patient outcomes.

Transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia ( BPH) . Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm la-

Significance of preoperative detrusor contractility to the postoperative assessment of prostatectomy for benign prostatic hyperplasia

Objective To study the value of preoperative detrusor contractility to the outcome assessment of prostatectomy for benign prostatic hyperplasia ( BPH) . Methods A total of 109 patients with BPH were analyzed. Their ages ranged from 62 to 83 years with a mean of

Effect of self-management on lower urinary tract symptoms and life quality of benign prostatic hyperplasia patients

Objective To evaluate the efficacy of self-management to improve the lower urinary tract symptoms ( LUTS) and life quality in benign prostatic

Clinical study of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia with overactive bladder

Objective To evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH) with overactive bladder ( OAB) . Methods 82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia （BPH） and to evaluate their clinical and voiding outcome. Methods： A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score （IPSS）, quality of life score （QoL）, uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results： All patients got through the perioperative period safely. The chief advantages of PVP were： short operative time （25.6 ± 7.6 min）, little bleeding loss （56.8 ± 14.3 mL） and short indwelling catheterization （1.6 ± 0.8 d）. The IPSS and QoL decreased from （29.6 ± 5.4） and （5.4 ± 0.6） to （9.5 ± 2.6） and （1.3 ± 0.6）, respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data （P 〈 0.05）. No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion： PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

nfluence of immune inflammation on androgen receptor expression in benign prostatic hyperplasia tissue

This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specimens. An immune inflammation score for each specimen was defined by combining three immunohistochemical markers （CD4, CD8 and CD20）. The immunohistochemical markers were CD4 and CD8 for T lymphocytes, CD20 for B lymphocytes and AR antibody for the AR in BPH samples. Rates of CD4, CD8, CD20 and AR expression in BPH were 20 （19.0%）, 21 （20.0%）, 101 （96.2%） and 48 （45.7%）, respectively. Total prostate volume （TPV） was higher in the immune inflammation group than in the non-immune inflammation group （62.7 ml vs. 49.2 ml, t=-2.482, P〈0.05）. Patients in the immune inflammation group had a higher serum prostate-specific antigen （PSA） than those in the non-inflammation group （7.5 ng m1-1 vs. 5.4 ng m1-1, t=-2.771, P〈0.05）. Specifically, the immune inflammation group showed a higher rate of AR expression than the non-inflammation group （56.1% vs. 28.2%, χ2=7.665, P〈0.05）. Our study revealed a strong association between immune inflammation and TPV, serum PSA and AR expression in BPH tissue. Prostate hyperplasia caused by an immune inflammatory process may contribute to BPH progression over time. Therefore, the inflammatory response involved in BPH may be a prime therapeutic target.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Human benign prostatic hyperplasia heterotransplants as an experimental model

Benign prostatic hyperplasia is a nonmalignant adenomatous enlargement of the pefiurethral prostate gland. It is a common disease in older men. In addition to man,spontaneous benign prostatic hyperplasia occurs in chimpanzee and the dog. Alternatives to these spontaneous models are induced benign prostatic hyperplasia,xenografts and in vitro models. Xenografts may be induced by cells cultured in vitro or by the heterotransplantation of primary surgical specimens into immunosuppressed mice. The purpose of this review is to integrate data from more than 30 years of heterotransplantation research in the study of benign hyperplasia of the prostate. Heterotransplantation has provided data regarding the histopathology,morphology,tissue markers,androgen receptor expression,tissue kinetics,take rate and tissue vasculature for this prostate disease.There are advantages,as well as limitations,that have been identified for human prostate disease heterotransplants versus xenotransplantation of cultured cells.Overall,heterotransplanted tissue is better at retaining tissue morphology,pathology,secretory activity,expression of tissue markers and human vasculature of the patient＇s original specimen. Furthermore,heterotransplanted tissue preserves the three-dimensional tissular architecture of the prostate to maintain critical stromal-epithelial cell interactions.

Epidemiology of clinical benign prostatic hyperplasia

Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with a prevalence of 8%-60% at age 90 years.Some data have suggested that there is decreased risk among the Asians compared to the western white population.Genetics,diet and life style may play a role here.Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction,as well as the possible role of inflammation as a cause of the prostatic hyperplasia.Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.