BPH is a non-cancerous proliferation of glandular epithelium and connective tissue stroma within the periurethral prostate gland that results in bladder outlet obstruction.  Irritative symptoms attributed to detrusor muscle overactivity are often reported as the most bothersome and are sometimes classified as overactive bladder symptoms. The cause of the BPH, which is variable in location and extent within the gland, is unknown1. Taken together, the obstructive and irritative effects are referred to as lower urinary tract symptoms (LUTS), and can dramatically decrease quality of life. Treatment currently consists of medication for milder cases and surgical techniques for more advanced obstruction

Understanding the basic biology, physiology and pathogenesis of BPH is of critical importance to making progress. These types of studies would provide the background to understand fundamental issues, including: how to distinguish between LUTS caused by processes in the bladder from that in the prostate, The persistence of LUTS in some men, even after obstruction has demonstrably been surgically removed, cannot be addressed without a better understanding of the pathogenesis of this condition.

The relationship between BPH and comorbidities needs to be understood at a molecular, cellular and tissue level.  LUTS has been linked to erectile dysfunction. It is not known if this is a causal relationship (i.e., does LUTS due to BPH influence erectile function or abnormal sexual function, or do diminished erections influence LUTS). Recent data have also linked LUTS and the metabolic syndrome. The relationship between LUTs and other potential comorbidities, such as diabetes and vascular pathology, should be examined.

Application of advanced imaging techniques, such as targeted nano-particles, fluorescent in situ hybridization (FISH) and fluorescent antibody markers of surface molecules must be implemented to unravel the complex transcriptional changes that cause changes in the growth patterns of urothelial and mesenchymal cells. Epigenetic manipulations, such as the use of small interfering RNAs, could result from an understanding of these changes. The existence of populations of epithelial and mesenchymal stem-like cells in the murine prostate indicates a promising area of translational research that may have implications for BPH and prostate cancer. While existing animal and in vitro models of BPH have served to advance our understanding, new generation models that more closely recapitulate the human condition must be developed to stimulate future progress. An increased understanding of the genetics of BPH would facilitate the development of such models.

Journal of Nephrology and Urology is an Open Access peer-reviewed publication that discusses current research and advancements in diagnosis and management of kidney disorders as well as related epidemiology, pathophysiology and molecular genetics.

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Journal of Nephrology and Urology
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