**9. Conclusion**

Benign prostatic hyperplasia and chronic kidney disease are two common and prevalent entities in elderly men. It has been reported in several studies that threads of evidence suggest that BPH is a risk factor for chronic kidney disease. An average of 13,6% patients presenting to urologic clinics for the treatment of BPH had renal failure. The low occurrence of CKD in BPH clinical trials should not be used to infer a weak association between these two disease processes (Rule et al., 2005). From our own experience we deem that the average of patients with BPH and some degree of renal disease can be higher, mostly because older men most of the times ignore their micturition problems and seek for clinical help just in a later degree of BPH.

Although BPH is not a life-threatening condition, the impact BPH on quality of life (QoL) can be significant and should not be underestimated. On the other hand CKD is an important medical problem that can even be critical (Fox, Larson et al. 2004)

Benign Prostate Hyperplasia and Chronic Kidney Disease 371

Barry, M. J., F. J. Fowler, Jr., et al. (1992). "The American Urological Association symptom

American Urological Association." *J Urol* 148(5): 1549-1557; discussion 1564. Bent, S., C. Kane, et al. (2006). "Saw palmetto for benign prostatic hyperplasia." *N Engl J Med*

Berry, S. J., D. S. Coffey, et al. (1984). "The development of human benign prostatic

Boesch, S. T., G. Dobler, et al. (2000). "Effects of alpha1-adrenoceptor antagonists on cultured

Boyle, P., A. L. Gould, et al. (1996). "Prostate volume predicts outcome of treatment of

Carter, H. B. and D. S. Coffey (1990). "The prostate: an increasing medical problem." *Prostate*

Chai, T. C., K. E. Andersson, et al. (2000). "Altered neural control of micturition in the aged

Christ, G. J. and M. Liebert (2005). "Proceedings of the Baltimore smooth muscle meeting:

Clark, R. V., D. J. Hermann, et al. (2004). "Marked suppression of dihydrotestosterone in

Cockett, A. T., M. J. Barry, et al. (1992). "Indications for treatment of benign prostatic

Comiter, C. V., M. P. Sullivan, et al. (1997). "Urodynamic risk factors for renal dysfunction in

Coroneos, E., M. Assouad, et al. (1997). "Urinary obstruction causes irreversible renal failure by inducing chronic tubulointerstitial nephritis." *Clin Nephrol* 48(2): 125-128. de Souza, P. A., A. Palumbo, Jr., et al. (2011). "Effects of a nanocomposite containing

Debruyne, F., G. Koch, et al. (2002). "Comparison of a phytotherapeutic agent (Permixon)

Desautel, M. G., T. L. Burney, et al. (1998). "Outcome of vaportrode transurethral

Donovan, J. L., T. J. Peters, et al. (2000). "A randomized trial comparing transurethral

Duncan, M. E. and M. J. Goldacre (2011). "Mortality trends for benign prostatic hyperplasia and prostate cancer in English populations 1979-2006." *BJU Int* 107(1): 40-45.

benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical

identifying research frontiers and priorities for the lower urinary tract." *J Urol*

men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase

hyperplasia. The American Urological Association Study." *Cancer* 70(1 Suppl): 280-

men with obstructive and nonobstructive voiding dysfunction." *J Urol* 158(1): 181-

Orbignya speciosa lipophilic extract on Benign Prostatic Hyperplasia." *J* 

with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study." *Eur Urol* 41(5): 497-506;

vaporization of the prostate using pressure-flow urodynamic criteria." *Urology*

resection of the prostate, laser therapy and conservative treatment of men with symptoms associated with benign prostatic enlargement: The CLasP study." *J Urol*

354(6): 557-566.

16(1): 39-48.

173(4): 1406-1409.

283.

185.

hyperplasia with age." *J Urol* 132(3): 474-479.

trials." *Urology* 48(3): 398-405.

F344 rat." *Urol Res* 28(5): 348-354.

*Ethnopharmacol* 135(1): 135-146.

discussion 506-497.

51(6): 1013-1017.

164(1): 65-70.

prostatic smooth muscle cells." *Prostate Suppl* 9: 34-41.

inhibitor." *J Clin Endocrinol Metab* 89(5): 2179-2184.

index for benign prostatic hyperplasia. The Measurement Committee of the

It has been well documented that bladder outlet obstruction by an enlarging prostate can lead to renal insufficiency. Relationship between symptoms severity and elevated serum creatinine in men with BPH have not been well defined. Recent data make us believe that combination of all these factors leading to chronic and progressive urinary retention, high bladder pressure, ureterohydronephrosis work together causing progressive renal injury. Obstructive process root cellular and physiological changes in bladder muscle and collagen, contribute to a high pressure bladder that perpetuates itself with worsening ability to empty and causing kidney lesions leading to renal failure.

The advent of medical treatment has obviated the need for surgery in many patients with BPH. Men in acute urinary retention or those with urinary tract infection and other BPHcomplications, may benefit from more aggressive BPH treatment to prevent renal failure, especially if the conditions are recurrent.

Other kidney risk factors such as diabetes mellitus, cardiovascular disease, hypertension, obesity and dyslipidemia may also be considered in the patient with BPH. Etiology of CKD is often multifactorial and BPH may accelerate the progression of CKD in other disease processes.

Older men with BPH often tolerate and ignore lower urinary tract symptoms and may not present for medical consultation until they develop uremic syndrome. Thus, these patients should have prostatic obstruction considered during evaluation and treatment as this diagnosis can be easily missed in unreported LUTS. Close follow-up is mandatory.

We emphasize that CKD secondary to BPH is a preventable disease, and if early detected can prevent costs of CKD treatment (including hemodialysis) with considerable saves (economic, health care, social).

Findings that we mentioned in this chapter suggest that progressive nephropathy caused by prostatic/bladder outflow obstruction – urinary outflow obstruction – might be averted by more adequate screening of renal function in men with untreated BPH.
