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Prostatic fibrosis, lower urinary tract symptoms, and BPH

Nature Reviews Urology volume 10, pages 546–550 (2013)Cite this article

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Abstract

Lower urinary tract symptoms (LUTS)—constituting a spectrum disorder that encompasses weak stream, nocturia, and sensations of incomplete emptying and intermittent or hesitant urination—are indicative of lower urinary tract dysfunction (LUTD). LUTD is a progressive disease that can lead to bladder dysfunction if left untreated or treated ineffectively. Sequelae include urinary retention, recurrent UTI, bladder calculi, and, eventually, renal impairment. LUTD involving the prostate is associated with both ageing and inflammation. Tissue inflammation resulting from ageing, infection, or other inflammatory disease processes (for example, type 2 diabetes mellitus) is epidemiologically associated with the subsequent development of tissue fibrosis in multiple organ systems, including the prostate. Recent studies show that tissue fibrosis in the lower urinary tract is associated with LUTD, and suggest that fibrosis might be a previously unrecognized pathobiology that contributes to LUTD. Thus, antifibrotic therapeutic agents should be considered as a new approach to efficaciously treating men with LUTD, especially those who don't experience durable responses to 5α-reductase inhibitors or α-adrenergic receptor antagonists.

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Figure 1: Prostatic pathobiologies that contribute towards lower urinary tract dysfunction.
Figure 2: Contribution of inflammation and fibrosis to lower urinary tract dysfunction (LUTD).
Figure 3: Myofibroblast phenoconversion and the initiation of fibrosis in the prostate.

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Authors and Affiliations

  1. Program in Cellular and Molecular Biology, The University of Michigan, 2966 Taubman Medical Library, Ann Arbor, 48109-0619, MI, USA

    Jose A. Rodriguez-Nieves

  2. Department of Biology, The University of Massachusetts, 100 Morrissey Boulevard, Boston, 02125-3393, MA, USA

    Jill A. Macoska

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Correspondence to Jill A. Macoska.

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Rodriguez-Nieves, J., Macoska, J. Prostatic fibrosis, lower urinary tract symptoms, and BPH. Nat Rev Urol 10, 546–550 (2013). https://doi.org/10.1038/nrurol.2013.149

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