Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia

Cosimo De Nunzio, Andrea Salonia, Mauro Gacci, Vincenzo Ficarra

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Pages (from-to)2771-2779
Number of pages9
JournalWorld Journal of Urology
Issue number11
Publication statusPublished - Nov 1 2020


  • Medical therapy
  • Phytotherapy
  • Progression
  • Prostatic hyperplasia
  • Prostatic inflammation
  • Serenoa repens

ASJC Scopus subject areas

  • Urology


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