Prostatic Fibrosis is Associated with Lower Urinary Tract Symptoms

Abstract

Purpose Current therapies for male lower urinary tract symptoms secondary to prostate enlargement prevent hormonal effects on prostate growth and inhibit smooth muscle contraction to ease bladder neck and urethral pressure. However, lower urinary tract symptoms can be refractory to these therapies, suggesting that additional biological processes not addressed by them may also contribute to lower urinary tract symptoms. Aging associated fibrotic changes in tissue architecture contribute to dysfunction in multiple organ systems. Thus, we tested whether such changes potentially have a role in impaired urethral function and perhaps in male lower urinary tract symptoms. Materials and Methods Periurethral tissues were obtained from a whole prostate ex vivo and from 28 consecutive men treated with radical prostatectomy. Lower urinary tract symptoms were assessed using the American Urological Association symptom index. Prostate tissues were subjected to mechanical testing to assess rigidity and stiffness. Fixed sections of these tissues were evaluated for collagen and elastin content, and glandularity to assess fibrosis. Statistical analysis included the Student t test and calculation of Pearson correlation coefficients to compare groups. Results Periurethral prostate tissues demonstrated nonlinear viscoelastic mechanical behavior. Tissue from men with lower urinary tract symptoms was significantly stiffer (p = 0.0016) with significantly higher collagen content (p = 0.0038) and lower glandularity than that from men without lower urinary tract symptoms (American Urological Association symptom index 8 or greater vs 7 or less). Conclusions Findings show that extracellular matrix deposition and fibrosis characterize the periurethral prostate tissue of some men with lower urinary tract symptoms. They point to fibrosis as a factor contributing to lower urinary tract symptom etiology.

Antagonists of growth hormone-releasing hormone inhibit proliferation induced by inflammation in prostatic epithelial cells

“…In the past few years, essential roles for fibrosis consequent to inflammation and aging in the development of LUTSs have been suggested (48). Fibrosis is defined as the progressive buildup of fibrotic connective tissue involving an increased number of myofibroblasts emerging through the transdifferentiation of epithelial cells and fibroblasts (49).…”

Is Periurethral Calcification Associated With Urinary Flow Rate and Symptom Severity in Men With Lower Urinary Tract Symptoms-Benign Prostatic Hyperplasia? A Retrospective Review

“…Recently, prostatic fibrosis, especially periurethral fibrosis, has been suggested as a novel cause of LUTS in men. 1,5,6,8 Since 2012, the periurethral area has been focused on as a key region determining LUTS severity. Ma et al 6 analyzed periurethral tissues obtained from radical prostatectomies and demonstrated that periurethral tissue from men with LUTS was significantly stiffer with higher collagen content and lower glandularity compared with men without LUTS.…”

Computer-Assisted Quantitative Assessment of Prostatic Calcifications in Patients with Chronic Prostatitis

“…This can be explained by the more frequent presence of infection of the prostatic fluid in presence of prostatic stones or by a mechanical effect of the less compliant prostatic tissue due to fibrosis and calcifications. In fact, a study of whole pathological prostates surgically removed has shown that in patients with symptoms of lower urinary tract can be demonstrated a fibrous periurethral area with extracellular matrix deposition [24]. Our study presents some limitations that must be considered in evaluating the results.…”