The role of the urinary microbiome on male benign prostatic hyperplasia (BPH) and its management using probiotic supplementation: a narrative review.

Benign prostatic hyperplasia (BPH) is highly prevalent and associated with a significant impact on individuals' well-being. Initial management involves various medications, but their benefits can be limited by side effects, particularly concerning young people. In this context, novel and better-tolerated therapeutic strategies have been proposed, thus including the modulation of the gut microbiome through probiotic ingestion. We aimed to examine the available evidence linking the urinary microbiome to lower urinary tract symptoms (LUTS) and to evaluate the possible usefulness of probiotic supplementation as a novel treatment option for LUTS/BPH. A narrative review design was preferred to fulfill our purpose. The search strategy included a range of terms, e.g., "microbiome," "microbiota," "urobiome," AND/OR "probiotics" AND "benign prostatic hyperplasia," "benign prostatic enlargement," "lower urinary tract symptoms." A range of studies aimed to investigate the possible impact of urinary microbiome on BPH. Gut and/or urinary dysbiosis can alter the gut permeability and initiate/maintain inflammatory and oxidative processes in the prostate, which may contribute to the cell-hyper-proliferation leading to BPH. The modulation of the urinary and/or gut microbiome through probiotic supplementation seems to provide levels of clinical effectiveness in the management of BPH. Although different probiotics have been tested, a combination of B. Longum and F. Psychaerophilum seems to be particularly promising due to their capability of modulating both the inflammatory pathway and the intestinal barrier permeability. Gut and/or urinary microbiome dysbiosis is most likely contributing to the BPH pathogenesis. Even though only scarce evidence on the potential usefulness of probiotic supplementation in the management of BPH is currently available, the available studies seem to provide encouraging results. Further prospective trials are warranted in order to confirm these findings and to clarify which probiotic strains are more suitable for supplementation in this setting.