ORIGINAL RESEARCH article
Front. Physiol.
Sec. Clinical and Translational Physiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1612954
Voiding symptom severity varies independently from nonadrenergic prostate smooth muscle contractions in patients undergoing surgery for benign prostatic hyperplasia
Provisionally accepted
Patrick KellerSheng HuPhilip NicolaLaurenz Berger
Alexander TamalunasPhilipp WeinholdChristian G Stief
Martin Hennenberg*- Department of Urology, LMU University Hospital, LMU Munich, Munich, Bavaria, Germany
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Background: Resistance of voiding symptoms to α1-blockers in benign prostatic hyperplasia (BPH) has been provisionally explained by non-adrenergic prostate smooth muscle contraction. Here, we examined relationships between contractions and voiding symptoms in prostate tissues from laser-enucleation. Methods: Tissues were obtained from holmium and thulium laser enucleation. Contractions were induced by endothelin-1, U46619, noradrenaline and electric field stimulation (EFS). Emax values were analyzed for correlation with international prostate symptom score (IPSS), and compared to tissues from patients without surgery for BPH. Results: Noradrenaline-and EFS-induced contractions were higher with severe (IPSS 20-35) than moderate symptoms (IPSS 8-19) (Emax noradrenaline 66% vs. 113% of KCl-induced contractions; EFS 33% vs. 66%). Endothelin-1 and U46619-induced contractions were already maximum with moderate symptoms (endothelin-1 117% moderate, 135% severe; U46619 23%, 27%). Within 8-21 points, IPSS increased with Emax values for noradrenaline and EFS (r=0.545, r=0.448), but not with endothelin-1-or U46619-induced contractions. Endothelin-1-induced contractions were similar to noradrenaline-induced contractions (Emax endothelin-1 126% of KCl, noradrenaline 96%), and exceeded EFS-(52%) and U46619-induced contractions (25%). Emax values for endothelin-1 were similar between laser-enucleated patients and patients without surgery for BPH (127%), while Emax values for U46619 were higher in tissues from patients without surgery for BPH (59%) compared to laser-enucleated tissues. Conclusions: Symptom severity increases with α1-adrenergic, but not with non-adrenergic contractions in patients undergoing surgery for BPH. Endothelin-1induced contractions are similar to noradrenaline-induced contractions. Conditions necessitating BPH surgery may not necessarily depend on α1-adrenergic tone, but may involve non-adrenergic contractions or factors beyond contraction.
Keywords: Benign prostatic hyperplasia (BPH), Voiding symptoms, Lower urinary tract symptoms (LUTS), International prostate symptom score (IPSS), Holmium laser enucleation of the prostate (HoLEP), smooth muscle contraction, Human Tissue
Received: 16 Apr 2025; Accepted: 16 May 2025.
Copyright: © 2025 Keller, Hu, Nicola, Berger, Tamalunas, Weinhold, Stief and Hennenberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Martin Hennenberg, Department of Urology, LMU University Hospital, LMU Munich, Munich, Bavaria, Germany
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