Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Association between prostatic inflammation and detrusor overactivity in men with benign prostatic hyperplasia and bladder outlet obstruction: a prospective urodynamic and histological study

Prostate Cancer and Prostatic Diseases (2025)Cite this article

Subjects

Abstract

Background

Benign prostatic hyperplasia (BPH) frequently leads to bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in aging men. Detrusor overactivity (DO) is a common functional consequence of BOO, often persisting even after surgical intervention. Prostatic inflammation (PI) has been implicated in BPH pathogenesis, but its relationship with DO remains unclear. This study aimed to evaluate the association between histologically confirmed PI and DO in men undergoing transurethral resection of the prostate (TURP) for BPH-related BOO.

Methods

We conducted a prospective, observational study involving 125 men aged ≥50 years with BPH, BOO confirmed by pressure-flow studies, and moderate-to-severe LUTS (IPSS ≥ 7). All patients had received standard medical therapy and were candidates for TURP. Urodynamic testing was performed before and three months after surgery. Based on baseline urodynamic findings, patients were categorized into two groups: those with DO (Group A) and those without (Group B). Resected prostate tissue was examined histologically, and PI was graded using the Irani score. Statistical analysis was performed using SPSS v26, with odds ratios (OR) and 95% confidence intervals (CI) reported.

Results

Prostatic inflammation was identified in 78.4% of patients overall and was significantly more prevalent in those with DO (84.9% vs. 69.2%; OR = 2.47, 95% CI: 1.11–5.49, p = 0.02). Inflammation was also more severe in Group A. DO resolved postoperatively in 75.3% of patients, while persistent DO was associated exclusively with moderate-to-severe PI. The odds of persistent DO following TURP were significantly higher in this subgroup (OR = 4.00, 95% CI: 1.33–12.05).

Conclusions

Prostatic inflammation is more frequent and severe in men with DO and is associated with its persistence after TURP. These findings suggest that PI contributes to both the pathogenesis and postoperative course of DO, supporting its role as a therapeutic target in BPH-related LUTS management.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Data availability

The datasets generated and analyzed during the current study are not publicly available due to institutional restrictions and participant confidentiality but are available from the corresponding author on reasonable request. All relevant data supporting the findings of this study are included in the main manuscript or are available upon request for academic and non-commercial purposes.

References

  1. Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7:S3–14.

    PubMed  PubMed Central  Google Scholar 

  2. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104:352–60.

    Article  PubMed  Google Scholar 

  3. Management of non-neurogenic male LUTS. EAU Guidelines. Edn. presented at the EAU Annual Congress 2024.

  4. Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2019;202:558–63. https://doi.org/10.1097/JU.0000000000000309.

    Article  PubMed  Google Scholar 

  5. Abrams P, Chapple CR, Khoury S, Roehrborn C, de la Rosette J. International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009;181:1779–87.

    Article  CAS  PubMed  Google Scholar 

  6. Robert G, Descazeaud A, Nicolaïew N, Terry S, Sirab N, Vacherot F, et al. Inflammation in benign prostatic hyperplasia: a 282 patients’ immunohistochemical analysis. Prostate. 2009;69:1774–80.

    Article  PubMed  PubMed Central  Google Scholar 

  7. De Nunzio C, Kramer G, Marberger M, Montironi R, Nelson W, Schröder F, et al. The controversial relationship between benign prostatic hyperplasia and prostate cancer: the role of inflammation. Eur Urol. 2011;60:106–17.

    Article  PubMed  Google Scholar 

  8. Nickel JC, Roehrborn CG, O’Leary MP, Bostwick DG, Somerville MC, Rittmaster RS, et al. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur Urol. 2008;54:1379–84.

    Article  PubMed  Google Scholar 

  9. Gravas S, De Nunzio C, Campos Pinheiro L, de León JP, Skriapas K, Milad Z, et al. Development and validation of a clinical nomogram to predict prostatic inflammation in men with lower urinary tract symptoms. Prostate Cancer Prostatic Dis. 2025;28:405–10. https://doi.org/10.1038/s41391-024-00857-5.

    Article  PubMed  Google Scholar 

  10. Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024;211:11–19. https://doi.org/10.1097/JU.0000000000003698.

    Article  PubMed  Google Scholar 

  11. Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, et al. A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment. Eur Urol. 2019;75:988–1000. https://doi.org/10.1016/j.eururo.2019.02.038.

    Article  PubMed  Google Scholar 

  12. Rosier PFWM, Schaefer W, Lose G, Goldman HB, Guralnick M, Eustice S, et al. International continence society good urodynamic practices and terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn. 2017;36:1243–60. https://doi.org/10.1002/nau.23124.

    Article  PubMed  Google Scholar 

  13. Irani J, Levillain P, Goujon JM, Bon, Doré B, Aubert J. Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol. 1997;157:1301–3.

    Article  CAS  PubMed  Google Scholar 

  14. Lombardo R, Ghezzo N, Sarcinelli L, Turchi B, Zammitti F, Franco A, et al. Post-voided residual ratio does not predict trifecta outcome after transurethral resection of prostate. Life. 2024;14:445 https://doi.org/10.3390/life14040445.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Oh MM, Choi H, Park MG, Kang SH, Cheon J, Bae JH, et al. Is there a correlation between the presence of idiopathic detrusor overactivity and the degree of bladder outlet obstruction? Urology. 2011;77:167–70. https://doi.org/10.1016/j.urology.2010.05.034.

    Article  PubMed  Google Scholar 

  16. Verhovsky G, Baberashvili I, Rappaport YH, Zilberman DE, Neheman A, Gal J, et al. Bladder oversensitivity is associated with bladder outlet obstruction in men. J Pers Med. 2022;12:1675 https://doi.org/10.3390/jpm12101675.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Penna G, Fibbi B, Amuchastegui S, Cossetti C, Aquilano F, Laverny G, et al. Human benign prostatic hyperplasia stromal cells as inducers and targets of chronic immuno-mediated inflammation. J Immunol. 2009;182:4056–64. https://doi.org/10.4049/jimmunol.0801875.

    Article  CAS  PubMed  Google Scholar 

  18. De Nunzio C, Giglio S, Stoppacciaro A, Gacci M, Cirombella R, Luciani E, et al. Autophagy deactivation is associated with severe prostatic inflammation in patients with lower urinary tract symptoms and benign prostatic hyperplasia. Oncotarget. 2017;8:50904–10. https://doi.org/10.18632/oncotarget.15144.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vignozzi L, Gacci M, Cellai IL, Morelli A, Maneschi E, Comeglio P, et al. PDE5 inhibitors blunt inflammation in human BPH: a potential mechanism of action for PDE5 inhibitors in LUTS. Prostate. 2013;73:1391–402. https://doi.org/10.1002/pros.22686.

    Article  CAS  PubMed  Google Scholar 

  20. Morelli AN, Comeglio P, Filippi S, Sarchielli E, Vignozzi L, Maneschi E, et al. Mechanism of action of phosphodiesterase type 5 inhibition in metabolic syndrome-associated prostate alterations: an experimental study in the rabbit. Prostate. 2013;73:428–41. https://doi.org/10.1002/pros.22584.

    Article  CAS  PubMed  Google Scholar 

  21. Gacci M, Vignozzi L, Sebastianelli A, Salvi M, Giannessi C, De Nunzio C, et al. Metabolic syndrome and lower urinary tract symptoms: the role of inflammation. Prostate Cancer Prostatic Dis. 2013;16:101–6. https://doi.org/10.1038/pcan.2012.44.

    Article  CAS  PubMed  Google Scholar 

  22. Vignozzi L, Cellai IL, Santi R, Lombardelli L, Morelli A, Comeglio P, et al. Antiinflammatory effect of androgen receptor activation in human benign prostatic hyperplasia cells. J Endocrinol. 2012;214:31–43. https://doi.org/10.1530/JOE-12-0142.

    Article  CAS  PubMed  Google Scholar 

  23. Russo GI, Vanella L, Castelli T, Cimino S, Reale G, Urzì D, et al. Heme oxygenase levels and metaflammation in benign prostatic hyperplasia patients. World J Urol. 2016;34:1183–92. https://doi.org/10.1007/s00345-015-1736-8.

    Article  CAS  PubMed  Google Scholar 

  24. Gacci M, De Nunzio C, Gravas S. Unveiling prostatic inflammation to optimize management of lower urinary tract symptoms: a discussion with experts. Biomark Med. 2023;17:739–45. https://doi.org/10.2217/bmm-2023-0365.

    Article  CAS  PubMed  Google Scholar 

  25. de Nunzio C, Franco G, Rocchegiani A, Iori F, Leonardo C, Laurenti C, et al. The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction. J Urol. 2003;169:535–9. https://doi.org/10.1097/01.ju.0000045600.69261.73.

    Article  PubMed  Google Scholar 

  26. Antunes AA, Iscaife A, Reis ST, Albertini A, Nunes MA, Lucon AM, et al. Can we predict which patients will experience resolution of detrusor overactivity after transurethral resection of the prostate? J Urol. 2015;193:2028–32. https://doi.org/10.1016/j.juro.2014.12.095.

    Article  PubMed  Google Scholar 

  27. Kim M, Jeong CW, Oh SJ. Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis. World J Urol. 2019;37:529–38. https://doi.org/10.1007/s00345-018-2402-8.

    Article  PubMed  Google Scholar 

  28. Dmochowski RR, Staskin D. Overactive bladder in men: special considerations for evaluation and management. Urology. 2002;60:56–62. https://doi.org/10.1016/s0090-4295(02)01797-1.

    Article  PubMed  Google Scholar 

  29. Ni J, Mizoguchi S, Bernardi K, Suzuki T, Kurobe M, Takaoka E, et al. Long-lasting bladder overactivity and bladder afferent hyperexcitability in rats with chemically-induced prostatic inflammation. Prostate. 2019;79:872–9. https://doi.org/10.1002/pros.23794.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Oelke M, Baard J, Wijkstra H, de la Rosette JJ, Jonas U, Höfner K, et al. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol. 2008;54:419–26. https://doi.org/10.1016/j.eururo.2008.02.017.

    Article  PubMed  Google Scholar 

  31. Bellucci CHS, Ribeiro WO, Hemerly TS, de Bessa JrJ, Antunes AA, Leite KRM, et al. Increased detrusor collagen is associated with detrusor overactivity and decreased bladder compliance in men with benign prostatic obstruction. Prostate Int. 2017;5:70–74. https://doi.org/10.1016/j.prnil.2017.01.008.

    Article  PubMed  PubMed Central  Google Scholar 

  32. De Nunzio C, Salonia A, Gacci M, Ficarra V. Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia. World J Urol. 2020;38:2771–9. https://doi.org/10.1007/s00345-020-03106-1.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Samarinas M, Gacci M, de la Taille A, Gravas S. Prostatic inflammation: a potential treatment target for male LUTS due to benign prostatic obstruction. Prostate Cancer Prostatic Dis. 2018;21:161–7. https://doi.org/10.1038/s41391-018-0039-8.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the staff of the Urodynamics Clinic and the Pathology Laboratory for their technical assistance and support during the study. No external funding or commercial sponsorship was received for this research. All materials used in this study were available through routine clinical care and standard institutional resources.

Author information

Authors and Affiliations

  1. 2nd Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Evangelos Varelas, Merkourios Kolvatzis & Michael Samarinas

  2. General Hospital of Larissa, Larissa, Greece

    Georgios Antoniadis

  3. Urologist, Private Practice, Larissa, Greece

    Aikaterini Tsionga

  4. Medical School, University of Cyprus, Nicosia, Cyprus

    Stavros Gravas

  5. Pathologist, University of Thessaly, Larissa, Greece

    Konstantina Zacharouli

Authors
  1. Evangelos Varelas
    View author publications

    Search author on:PubMed Google Scholar

  2. Georgios Antoniadis
    View author publications

    Search author on:PubMed Google Scholar

  3. Aikaterini Tsionga
    View author publications

    Search author on:PubMed Google Scholar

  4. Merkourios Kolvatzis
    View author publications

    Search author on:PubMed Google Scholar

  5. Stavros Gravas
    View author publications

    Search author on:PubMed Google Scholar

  6. Konstantina Zacharouli
    View author publications

    Search author on:PubMed Google Scholar

  7. Michael Samarinas
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Varelas Evangelos conducted data interpretation and drafted the manuscript. Antoniadis Georgios contributed to patient recruitment, clinical data collection, and manuscript revision. Tsionga Aikaterini participated in patient follow-up, urodynamic testing, and data analysis. Kolvatzis Merkourios assisted in surgical procedures, literature review, and manuscript editing. Gravas Stavros provided critical revision of the manuscript for important intellectual content and supervised the research process. Zacharouli Konstantina performed the histopathological analyses and contributed to the interpretation of inflammation scoring. Samarinas Michael conceived and designed the study, coordinated the urodynamic assessments, contributed to study design, and reviewed the final draft for accuracy. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Michael Samarinas.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Scientific Council of General Hospital of Larissa, Greece, and all procedures involving human participants were conducted in accordance with the ethical standards of the institutional and national research committees, as well as the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all participants prior to inclusion in the study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Varelas, E., Antoniadis, G., Tsionga, A. et al. Association between prostatic inflammation and detrusor overactivity in men with benign prostatic hyperplasia and bladder outlet obstruction: a prospective urodynamic and histological study. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-01039-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41391-025-01039-7

Search

Advanced search

Quick links