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Current Opinion in Urology:
doi: 10.1097/MOU.0000000000000009

BPH: big disease with a little name

Reich, Oliver

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Department of Urology, Klinikum Harlaching, Teaching-Hospital Ludwig-Maximilians-University, Munich, Germany

Correspondence to Oliver Reich, MD, Professor of Urology, Chairman Department of Urology, Klinikum Harlaching, Teaching-Hospital Ludwig-Maximilians-University Sanatoriumsplatz 2, 81545 Munich Germany. Tel: +49 89 6210 2791; e-mail:

Actually, the title should read: BPH/LUTS/BPO/BPE – big diseases with little names. The continuing misuse of the term ‘BPH’ or ‘prostatism’ is covered by an article by Paul Abrams et al. (pp. 3–9) in this section. Moreover, the author gives his profound view on the paradigm shift in male lower urinary tract symptoms (LUTS). A shift away from seeing the prostate as the only ‘evil’ in LUTS. Next to recognizing the bladder as an important player, especially regarding storage, the article preaches a patient-focused and symptom-focused assessment and management using current guidelines.

Male LUTS is of paramount impact on aging men. However, regarding research and funding efforts it is very often neglected compared with oncology-related entities.

J. Kellogg Parsons is a prominent exception in the field. His article (pp. 10–14) on the cause elucidates the associations of obesity, physical activity, and diet with benign prostatic hyperplasia (BPH) and LUTS. His group reviewed, that obesity and consumption of meat and fat are modifiable factors associated with significantly increased risks of symptomatic BPH and LUTS. Thus, the authors find it reasonable to promote weight loss, exercise, and healthy diet within the context of standard treatments for symptomatic BPH and LUTS.

Concerning evaluation and diagnosis of LUTS, Chris Chapple (pp. 15–20) focuses on less invasive methods of cystometry. Although these do not provide the identical information as cystometry itself, in the authors opinion, they may have a role in answering particular questions and counseling men with BPH/LUTS.

On the therapeutic side, Francisco Cruz et al. review (pp. 21–28) current developments in the medical treatment on LUTS. They summarize that standard medical treatment is still based on α-blockers, 5-α-reductase inhibitors or its combination. In addition, the authors assess the emerging role of antimuscarinics, 5-phosphodiesterase inhibitors, and β3-adrenoreceptor agonists. In the future the authors expect that medical treatment will become individualized, according to the type of symptoms, presence of sexual dysfunction, and risk progression.

The topic of pipeline compounds and very recent developments in drug treatment is covered by Christian Gratzke et al. (pp. 29–35). As examples, although they do not have official approval to treat male LUTS, mirabegron, a β3 agonist, and intravesical botulinum toxin, both of which have official approval for overactive bladder, are described as treatment alternatives to antimuscarinics. Also, the principle of intraprostatic drug injection, either with botulinum toxin or with proteins of supposedly specific apoptotic properties (such as NX-1207 and PRX302), is discussed. Moreover, candidates such as vitamin D3 receptor analogues (elocalcitol), gonadotropin releasing hormone antagonists (cetorelix), and cannabinoid derivates are introduced.

As it is a small step only which can in fact be seen as a continuum, Henry Woo's group (pp. 36–41) takes a close look on minimal invasive therapies. These range from intraprostatic injections to novel mechanical devices such as the Urolift, to very recent (experimental) techniques, such as Rezum, Histoptripsy, and Aquablation.

Stepping up on invasiveness, Alexander Bachmann et al. (pp. 42–48) report on the latest development of different techniques of vaporization of the prostate. Owing to the dominance of the Greenlight system in the field, they focus on the latest data on this technique. Also, the article covers diode laser vaporization, vapoenucleation, and vaporesection with thulium : YAG lasers as well as plasmakinetic vaporization.

Finally, Peter Gilling and his group (pp. 49–55) reflect on the different advances in enucleation procedures. The holmium laser as energy source is increasingly challenged by other lasers and plasmakinetic energy. The authors request randomized trials with longer follow-up to demonstrate whether these other types of energy source and tissue retrieval really have advantages in enucleation (speed, ease of use, hemostasis) as compared to the holmium laser. In their opinion, the selection of energy source in the future might be a matter of personal choice.

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Speaker honoraria for American Medical Systems.

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Conflicts of interest

There are no conflicts of interest.

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