COMBINATION OF BENIGN PROSTATIC OBSTRUCTION AND INFLAMMATORY CHANGES IN THE PROSTATE OF MEN: COMMON LINKS OF PATHOGENESIS AND POSSIBILITY OF THEIR MEDICATION TREATMENT

INTRODUCTION. The problem of benign prostatic obstruction is becoming more and more relevant every year both in the world and in Ukraine. In the world, several hundred million men suffer from benign prostatic obstruction, but the statistical indicators of the incidence and prevalence of benign prostatic obstruction in different regions of the world differ significantly. That is, statistics do not reflect the real epidemiological picture. benign prostatic obstruction negatively affects the quality of life of men. The purpose of this work is to reveal modern ideas about the physiology and pathophysiology of the inflammatory component in the prostate gland in benign prostatic obstruction and its modern treatment in men. MATERIALS AND METHODS. The materials used were literature on the results of world and European studies of recent years, as well as materials from the Guidelines of the European Association of Urologists for 2024 and 2025. RESULTS. Benign prostatic obstruction is a polyetiological disease of middle-aged and elderly men in the form of tissue hypertrophy in the area of the paraurethral glands, which leads to the formation of lower urinary tract syndrome. Its histological landscape is characterized by an increase in the epithelial pool and stromal component, i.e. collagen and smooth muscle elements in the paraurethral area. In histological preparations of the prostate gland in patients with benign prostatic obstruction, in addition to the hypertrophic component, an inflammatory component is found in parallel, as a result of previous infection, which led to the formation of foci of inflammation and is enhanced due to obstructive phenomena caused by focal hypertrophy of the gland tissue. The inflammatory process in the prostate gland is an important factor that causes and stimulates the growth of its volume and the progression of the lower urinary tract syndrome. The prevalence of the inflammatory component in the prostate gland in benign prostatic obstruction has not been studied yet, but this issue is currently considered relevant. The work identifies risk factors for the development of inflammatory proliferation in the prostate gland in patients with benign prostatic obstruction, but I would like to note the lack of clear ideas about the role of inflammation in the pathogenesis of benign prostatic obstruction, and the only theory so far is the hypothesis of an infectious factor. It is proved by studies of the detection of bacteria, viruses and protozoa in prostate tissue biopsies in benign prostatic obstruction. The intervention of microorganisms leads to a violation of the physiology of the prostate gland, which is due to the destructive effect of the inflammatory process, their toxic effect on the epithelial-stromal pool of cells for a long time, which enhances the release of pro-inflammatory factors. Benign prostatic obstruction is an immune inflammatory disease, and its pathogenesis and progression are associated with chronic inflammatory changes. Single lymphocytes in the structure of the prostate gland are first identified at 10 years old, in 30-year-old men histological signs of prostate volume with inflammatory infiltrates are already detected, in a large part of 40-year-olds histological markers of benign prostatic obstruction with dynamic changes in the activity of cell proliferation are formed. At the next stage, there is an increase in the volume of the prostate gland with the progression of the inflammatory process, which again increases with age and correlates with the syndrome of the lower urinary tract/benign prostatic obstruction. In the presence of inflammatory focal infiltrates, tissue damage progresses, forming a low-progressive hyperproliferative inflammatory component and another increase in the volume of the prostate gland. And this, in turn, leads to an increase in obstructive phenomena in its ducts with high proteolytic activity of the gland’s secretion, which causes the destruction of its periglandular tissues and has a destructive effect on the cells of the stromal framework. As a result of this process, the penetration of autoantigens with a local reaction of the immune system of the prostate gland deepens. Therefore, bacterial and non-infectious chronic prostatitis can be considered as a pathogenetic background for the implementation of hyperproliferative cellular pathways, which causes the formation of tissue autoimmune responses against self-antigens that are released after tissue damage. Understanding the pathogenesis of benign prostatic obstruction will allow pharmacologists and clinicians to develop and use new strategies in its treatment. The work also indicates factors that regulate the rate of progression of inflammatory hyperproliferation in prostate tissues and indicates methods of modern conservative therapy of patients based on strict adherence to the guidelines of the European Association of Urologists and the principles of evidence-based medicine. CONCLUSION. Bacterial and non-infectious chronic prostatitis can be considered as a pathogenetic background m implementation of hyperproliferative cellular pathways, which causes the formation of tissue autoimmune responses against self-antigens, which are released after tissue damage. The use of Serenoa repens extract is a promising direction of conservative treatment of patients with lower urinary tract syndrome/benign prostatic obstruction, as monotherapy for mild degrees and as combination therapy (α1-adrenoblockers, 5-phosphodiesterase inhibitors) for moderate degrees.