The Potential Role of Urinary Microbiome in Benign Prostate Hyperplasia/Lower Urinary Tract

16 Aug 2025 09:45 10:00
Horie ShigeoJapan Moderator
Seung Il JungKorea (Republic of) Speaker The Potential Role of Urinary Microbiome in Benign Prostate Hyperplasia/Lower Urinary TractHistorically, urine in the urinary tract was considered “sterile” based primarily on culture-dependent methods of bacterial detection. However, the advent of enhanced quantitative urine culture (EQUC) and 16S ribosomal RNA gene sequencing has revealed the presence of bacterial DNA and live bacteria in the urinary tract, fundamentally changing our understanding of the urogenital microbiome. Recent studies have demonstrated that healthy men, like women, possess distinct urinary tract microbiota. While evidence linking the urinary microbiota to lower urinary tract symptoms (LUTS) in women is accumulating, the association between urinary microbiota and LUTS in men, particularly those with benign prostatic hyperplasia (BPH), remains under investigation. Emerging evidence suggests that dysbiosis of the urinary microbiota may contribute to BPH development and symptom severity through mechanisms such as chronic prostatic inflammation, inflammasome activation (e.g., NLRP3), and microbial-driven DNA damage in prostate epithelial cells. Notably, organisms like Escherichia coli and Burkholderia spp. have been implicated in intraprostatic inflammation and progression of BPH. Additionally, the gut–prostate axis has gained attention as gut microbiota composition—particularly a high Firmicutes/Bacteroidetes ratio—has been associated with BPH via metabolic and immunological pathways. These findings open new avenues for microbiome-targeted therapies, including probiotics and modulation of intestinal microbiota, to prevent or manage male LUTS/BPH. This lecture reviews current evidence linking the urogenital microbiome to BPH pathogenesis and symptomatology in men. Despite promising findings, clinical translation remains limited due to heterogeneity in sampling methods and lack of robust, large-scale studies. Further research is required to validate microbial biomarkers and develop evidence-based, noninvasive strategies for prevention and treatment of male LUTS/BPH.