Schifano N, Capogrosso P, Baldini S, Villano A, Antonini G, Deho' F
ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy.
Eur Rev Med Pharmacol Sci. 2024 Dec;28(23):4671-4679. doi: 10.26355/eurrev_202412_36978.
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.
良性前列腺增生（BPH）非常普遍，对个人健康有重大影响。初始治疗包括各种药物，但它们的益处可能会受到副作用的限制，尤其是对于年轻人。在这种情况下，已经提出了新颖且耐受性更好的治疗策略，包括通过摄入益生菌来调节肠道微生物群。我们旨在研究将泌尿微生物群与下尿路症状（LUTS）联系起来的现有证据，并评估补充益生菌作为LUTS/BPH新治疗选择的潜在效用。为实现我们的目的，首选叙述性综述设计。检索策略包括一系列术语，例如“微生物群”“微生物区系”“泌尿微生物群”和/或“益生菌”以及“良性前列腺增生”“良性前列腺肿大”“下尿路症状”。一系列研究旨在调查泌尿微生物群对BPH的可能影响。肠道和/或泌尿微生物群失调可改变肠道通透性，并启动/维持前列腺中的炎症和氧化过程，这可能导致细胞过度增殖，进而引发BPH。通过补充益生菌来调节泌尿和/或肠道微生物群似乎在BPH的管理中具有一定的临床疗效。尽管已经测试了不同的益生菌，但长双歧杆菌和嗜冷栖热放线菌的组合似乎特别有前景，因为它们能够调节炎症途径和肠道屏障通透性。肠道和/或泌尿微生物群失调很可能是BPH发病机制的一个因素。尽管目前关于补充益生菌在BPH管理中的潜在效用的证据很少，但现有研究似乎提供了令人鼓舞的结果。有必要进行进一步的前瞻性试验，以证实这些发现，并明确哪种益生菌菌株更适合在这种情况下进行补充。
