Skip to main content
Top
Published in: BMC Urology 1/2014

Open Access 01-12-2014 | Review

Modern extraction techniques and their impact on the pharmacological profile of Serenoa repens extracts for the treatment of lower urinary tract symptoms

Authors: Celeste De Monte, Simone Carradori, Arianna Granese, Giovanni Battista Di Pierro, Costantino Leonardo, Cosimo De Nunzio

Published in: BMC Urology | Issue 1/2014

Login to get access

Abstract

Background

Bioactive compounds from plants (i.e., Serenoa repens) are often used in medicine in the treatment of several pathologies, among which benign prostatic hyperplasia (BPH) associated to lower urinary tract symptoms (LUTS).

Discussion

There are different techniques of extraction, also used in combination, with the aim of enhancing the amount of the target molecules, gaining time and reducing waste of solvents. However, the qualitative and quantitative composition of the bioactives depends on the extractive process, and so the brands of the recovered products from the same plant are different in terms of clinical efficacy (no product interchangeability among different commercial brands).

Summary

In this review, we report on several and recent extraction techniques and their impact on the composition/biological activity of S. repens-based available products.
Literature
1.
go back to reference De Nunzio C, Aronson W, Freedland S, Giovannucci E, Parsons JK: The correlation between metabolic syndrome and prostatic diseases. Eur Urol. 2012, 61: 560-571.CrossRefPubMed De Nunzio C, Aronson W, Freedland S, Giovannucci E, Parsons JK: The correlation between metabolic syndrome and prostatic diseases. Eur Urol. 2012, 61: 560-571.CrossRefPubMed
2.
go back to reference Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N’dow J, Nordling J, de la Rosette JJ: EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013, 64: 118-140.CrossRefPubMed Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N’dow J, Nordling J, de la Rosette JJ: EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013, 64: 118-140.CrossRefPubMed
3.
go back to reference Miano R, De Nunzio C, Asimakopoulos T, Germani S, Tubaro A: Treatment options for benign prostatic hyperplasia in elderly men. Med Sci Monit. 2008, 14: 94-102. Miano R, De Nunzio C, Asimakopoulos T, Germani S, Tubaro A: Treatment options for benign prostatic hyperplasia in elderly men. Med Sci Monit. 2008, 14: 94-102.
4.
go back to reference Cornu JN, Cussenot O, Haab F, Lukacs B: A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines. Eur Urol. 2010, 58: 450-456.CrossRefPubMed Cornu JN, Cussenot O, Haab F, Lukacs B: A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines. Eur Urol. 2010, 58: 450-456.CrossRefPubMed
5.
go back to reference Fourcade RO, Théret N, Taïeb C: Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries. BJU Int. 2008, 101: 1111-1118.CrossRefPubMed Fourcade RO, Théret N, Taïeb C: Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries. BJU Int. 2008, 101: 1111-1118.CrossRefPubMed
6.
go back to reference Suter A, Saller R, Riedi E, Heinrich M: Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytother Res. 2013, 27: 218-226.CrossRefPubMed Suter A, Saller R, Riedi E, Heinrich M: Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytother Res. 2013, 27: 218-226.CrossRefPubMed
7.
go back to reference MacDonald R, Tacklind JW, Rutks I, Wilt TJ: Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012, 109: 1756-1761.CrossRefPubMedPubMedCentral MacDonald R, Tacklind JW, Rutks I, Wilt TJ: Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012, 109: 1756-1761.CrossRefPubMedPubMedCentral
8.
go back to reference Azimi H, Khakshur AA, Aghdasi I, Fallah-Tafti M, Abdollahi M: A review of animal and human studies for management of benign prostatic hyperplasia with natural products: perspective of new pharmacological agents. Inflamm Allergy Drug Targets. 2012, 11: 207-221.CrossRefPubMed Azimi H, Khakshur AA, Aghdasi I, Fallah-Tafti M, Abdollahi M: A review of animal and human studies for management of benign prostatic hyperplasia with natural products: perspective of new pharmacological agents. Inflamm Allergy Drug Targets. 2012, 11: 207-221.CrossRefPubMed
9.
go back to reference Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ: Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012, 12: CD001423-PubMed Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ: Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012, 12: CD001423-PubMed
10.
11.
go back to reference Schantz MM, Bedner M, Long SE, Molloy JL, Murphy KE, Porter BJ, Putzbach K, Rimmer CA, Sander LC, Sharpless KE, Thomas JB, Wise SA, Wood LJ, Yen JH, Yarita T, NguyenPho A, Sorenson WR, Betz JM: Development of saw palmetto (Serenoa repens) fruit and extract standard reference materials. Anal Bioanal Chem. 2008, 392: 427-438.CrossRefPubMed Schantz MM, Bedner M, Long SE, Molloy JL, Murphy KE, Porter BJ, Putzbach K, Rimmer CA, Sander LC, Sharpless KE, Thomas JB, Wise SA, Wood LJ, Yen JH, Yarita T, NguyenPho A, Sorenson WR, Betz JM: Development of saw palmetto (Serenoa repens) fruit and extract standard reference materials. Anal Bioanal Chem. 2008, 392: 427-438.CrossRefPubMed
12.
go back to reference Chan CH, Yusoff R, Ngoh GC, Kung FWL: Microwave-assisted extractions of active ingredients from plants. J Chromatogr A. 2011, 1218: 6213-6225.CrossRefPubMed Chan CH, Yusoff R, Ngoh GC, Kung FWL: Microwave-assisted extractions of active ingredients from plants. J Chromatogr A. 2011, 1218: 6213-6225.CrossRefPubMed
13.
go back to reference Capitani D, Sobolev AP, Delfini M, Vista S, Antiochia R, Proietti N, Bubici N, Ferrante G, Carradori S, De Salvador FR, Mannina L: NMR methodologies in the analysis of blueberries. Electrophoresis. 2014, doi:10.1002/elps.201300629 Capitani D, Sobolev AP, Delfini M, Vista S, Antiochia R, Proietti N, Bubici N, Ferrante G, Carradori S, De Salvador FR, Mannina L: NMR methodologies in the analysis of blueberries. Electrophoresis. 2014, doi:10.1002/elps.201300629
14.
go back to reference Zhang HF, Yang XH, Wang Y: Microwave-assisted extraction of secondary metabolites from plants: current status and future directions. Trends Food Sci Tech. 2011, 22: 672-688.CrossRef Zhang HF, Yang XH, Wang Y: Microwave-assisted extraction of secondary metabolites from plants: current status and future directions. Trends Food Sci Tech. 2011, 22: 672-688.CrossRef
15.
go back to reference Shirsath SR, Sonawane SH, Gogate PR: Intensification of extraction of natural products using ultrasonic irradiations - a review of current status. Chem Eng Process. 2012, 53: 10-23.CrossRef Shirsath SR, Sonawane SH, Gogate PR: Intensification of extraction of natural products using ultrasonic irradiations - a review of current status. Chem Eng Process. 2012, 53: 10-23.CrossRef
16.
go back to reference Fornari T, Vicente G, Vàzquez E, Garcìa-Risco MR, Reglero G: Isolation of essential oil from different plants and herbs by supercritical fluid extraction. J Chromatogr A. 2012, 1250: 34-48.CrossRefPubMed Fornari T, Vicente G, Vàzquez E, Garcìa-Risco MR, Reglero G: Isolation of essential oil from different plants and herbs by supercritical fluid extraction. J Chromatogr A. 2012, 1250: 34-48.CrossRefPubMed
17.
go back to reference Akanda MJ, Sarker MZ, Ferdosh S, Manap MY, Ab Rahman NN, Ab Kadir MO: Applications of supercritical fluid extraction (SFE) of palm oil and oil from natural sources. Molecules. 2012, 17: 1764-1794.CrossRefPubMed Akanda MJ, Sarker MZ, Ferdosh S, Manap MY, Ab Rahman NN, Ab Kadir MO: Applications of supercritical fluid extraction (SFE) of palm oil and oil from natural sources. Molecules. 2012, 17: 1764-1794.CrossRefPubMed
18.
go back to reference Tang B, Bi W, Tian M, Row KH: Application of ionic liquid for extraction and separation of bioactive compounds from plants. J Chromatogr B. 2012, 904: 1-21.CrossRef Tang B, Bi W, Tian M, Row KH: Application of ionic liquid for extraction and separation of bioactive compounds from plants. J Chromatogr B. 2012, 904: 1-21.CrossRef
19.
go back to reference Puri M, Sharma D, Barrow CJ: Enzyme-assisted extraction of bioactives from plants. Trends Biotechnol. 2012, 30: 37-44.CrossRefPubMed Puri M, Sharma D, Barrow CJ: Enzyme-assisted extraction of bioactives from plants. Trends Biotechnol. 2012, 30: 37-44.CrossRefPubMed
20.
go back to reference Mustafa A, Turner C: Pressurized liquid extraction as a green approach in food and herbal plants extraction: A review. Anal Chim Acta. 2011, 703: 8-18.CrossRefPubMed Mustafa A, Turner C: Pressurized liquid extraction as a green approach in food and herbal plants extraction: A review. Anal Chim Acta. 2011, 703: 8-18.CrossRefPubMed
21.
22.
go back to reference Buck AC: Is there a scientific basis for the therapeutic effects of Serenoa repens in benign prostatic hyperplasia? mechanisms of action. J Urol. 2004, 172: 1792-1799.CrossRefPubMed Buck AC: Is there a scientific basis for the therapeutic effects of Serenoa repens in benign prostatic hyperplasia? mechanisms of action. J Urol. 2004, 172: 1792-1799.CrossRefPubMed
23.
go back to reference Habib FK, Wyllie MG: Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis. 2004, 7: 195-200.CrossRefPubMed Habib FK, Wyllie MG: Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis. 2004, 7: 195-200.CrossRefPubMed
24.
go back to reference Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C: Comparison of the potency of different brands of Serenoa repens extract on 5α-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells. Pharmacology. 2008, 82: 270-275.CrossRefPubMed Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C: Comparison of the potency of different brands of Serenoa repens extract on 5α-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells. Pharmacology. 2008, 82: 270-275.CrossRefPubMed
25.
go back to reference Raynaud JP, Cousse H, Martin PM: Inhibition of type 1 and type 2 5alpha-reductase activity by free fatty acids, active ingredients of Permixon. J Steroid Biochem Mol Biol. 2002, 82: 233-239.CrossRefPubMed Raynaud JP, Cousse H, Martin PM: Inhibition of type 1 and type 2 5alpha-reductase activity by free fatty acids, active ingredients of Permixon. J Steroid Biochem Mol Biol. 2002, 82: 233-239.CrossRefPubMed
26.
go back to reference Abe M, Ito Y, Suzuki A, Onoue S, Noguchi H, Yamada S: Isolation and pharmacological characterization of fatty acids from saw palmetto extract. Anal Sci. 2009, 25: 553-557.CrossRefPubMed Abe M, Ito Y, Suzuki A, Onoue S, Noguchi H, Yamada S: Isolation and pharmacological characterization of fatty acids from saw palmetto extract. Anal Sci. 2009, 25: 553-557.CrossRefPubMed
27.
go back to reference Abe M, Ito Y, Oyunzul L, Oki-Fujino T, Yamada S: Pharmacologically relevant receptor binding characteristics and 5α-reductase inhibitory activity of free fatty acids contained in Saw Palmetto extract. Biol Pharm Bull. 2009, 32: 646-650.CrossRefPubMed Abe M, Ito Y, Oyunzul L, Oki-Fujino T, Yamada S: Pharmacologically relevant receptor binding characteristics and 5α-reductase inhibitory activity of free fatty acids contained in Saw Palmetto extract. Biol Pharm Bull. 2009, 32: 646-650.CrossRefPubMed
28.
go back to reference Chua T, Eise NT, Simpson JS, Ventura S: Pharmacological characterization and chemical fractionation of a liposterolic extract of saw palmetto (Serenoa repens): effects on rat prostate contractility. J Ethnopharmacol. 2014, 152: 283-291.CrossRefPubMed Chua T, Eise NT, Simpson JS, Ventura S: Pharmacological characterization and chemical fractionation of a liposterolic extract of saw palmetto (Serenoa repens): effects on rat prostate contractility. J Ethnopharmacol. 2014, 152: 283-291.CrossRefPubMed
29.
go back to reference Baron M, Mancini E, Caldwell A, Cabrelle P, Bernardi F, Pagano F: Serenoa repens extract targets mitochondria and activates the intrinsic apoptotic pathway in human prostate cancer cells. BJUI. 2009, 103: 1275-1283.CrossRef Baron M, Mancini E, Caldwell A, Cabrelle P, Bernardi F, Pagano F: Serenoa repens extract targets mitochondria and activates the intrinsic apoptotic pathway in human prostate cancer cells. BJUI. 2009, 103: 1275-1283.CrossRef
30.
go back to reference Petrangeli E, Lenti L, Buchetti B, Chinzari P, Sale P, Salvatori L, Ravenna L, Lococo E, Morgante E, Russo A, Frati L, Di Silverio F, Russo MA: Lipido-sterolic extract of Serenoa repens (LSESr, Permixon®) treatment affects human prostate cancer cell membrane organization. J Cell Physiol. 2009, 219: 69-76.CrossRefPubMed Petrangeli E, Lenti L, Buchetti B, Chinzari P, Sale P, Salvatori L, Ravenna L, Lococo E, Morgante E, Russo A, Frati L, Di Silverio F, Russo MA: Lipido-sterolic extract of Serenoa repens (LSESr, Permixon®) treatment affects human prostate cancer cell membrane organization. J Cell Physiol. 2009, 219: 69-76.CrossRefPubMed
31.
go back to reference Latil A, Libon C, Templier M, Junquero D, Lantoine-Adam F, Nguyen T: Hexanic lipidosterolic extract of Serenoa repens inhibits the expression of two key inflammatory mediators, MCP-1/CCL2 and VCAM-1, in vitro. BJUI. 2012, 110: E301-E303.CrossRef Latil A, Libon C, Templier M, Junquero D, Lantoine-Adam F, Nguyen T: Hexanic lipidosterolic extract of Serenoa repens inhibits the expression of two key inflammatory mediators, MCP-1/CCL2 and VCAM-1, in vitro. BJUI. 2012, 110: E301-E303.CrossRef
32.
go back to reference Silvestri I, Cattarino S, Aglianò AM, Nicolazzo C, Scarpa S, Salciccia S, Frati L, Gentile V, Sciarra A: Effect of Serenoa repens (Permixon®) on the expression of inflammation-related genes: analysis in primary cell cultures of human prostate carcinoma. J Inflammation. 2013, 10: 11-19.CrossRef Silvestri I, Cattarino S, Aglianò AM, Nicolazzo C, Scarpa S, Salciccia S, Frati L, Gentile V, Sciarra A: Effect of Serenoa repens (Permixon®) on the expression of inflammation-related genes: analysis in primary cell cultures of human prostate carcinoma. J Inflammation. 2013, 10: 11-19.CrossRef
33.
go back to reference Sirab N, Robert G, Fasolo V, Descazeaud A, Vacherot F, de la Taille A, Terry S: Lipidosterolic extract of Serenoa repens modulates the expression of inflammation related-genes in benign prostatic hyperplasia epithelial and stromal cells. Int J Mol Sci. 2013, 14: 14301-14320.CrossRefPubMedPubMedCentral Sirab N, Robert G, Fasolo V, Descazeaud A, Vacherot F, de la Taille A, Terry S: Lipidosterolic extract of Serenoa repens modulates the expression of inflammation related-genes in benign prostatic hyperplasia epithelial and stromal cells. Int J Mol Sci. 2013, 14: 14301-14320.CrossRefPubMedPubMedCentral
34.
go back to reference Hostanska K, Suter A, Melzer J, Saller R: Evaluation of cell death caused by an ethanolic extract of Serenoae repentis fructus (Prostasan®) on human carcinoma cell lines. Anticancer Res. 2007, 27: 873-882.PubMed Hostanska K, Suter A, Melzer J, Saller R: Evaluation of cell death caused by an ethanolic extract of Serenoae repentis fructus (Prostasan®) on human carcinoma cell lines. Anticancer Res. 2007, 27: 873-882.PubMed
35.
go back to reference Iglesias-Gato D, Carsten T, Vesterlund M, Pousette A, Schoop R, Norstedt G: Androgen-independent effects of Serenoa repens extract (Prostasan) on prostatic epithelial cell proliferation and inflammation. Phytother Res. 2012, 26: 259-264.CrossRefPubMed Iglesias-Gato D, Carsten T, Vesterlund M, Pousette A, Schoop R, Norstedt G: Androgen-independent effects of Serenoa repens extract (Prostasan) on prostatic epithelial cell proliferation and inflammation. Phytother Res. 2012, 26: 259-264.CrossRefPubMed
36.
go back to reference Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH: Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction. Biochem Biophys Res Commun. 2009, 379: 795-798.CrossRefPubMed Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH: Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction. Biochem Biophys Res Commun. 2009, 379: 795-798.CrossRefPubMed
37.
go back to reference Yang Y, Ikezoe T, Zheng Z, Taguchi H, Koeffler HP, Zhu WG: Saw Palmetto induces growth arrest and apoptosis of androgen-dependent prostate cancer LNCaP cells via inactivation of STAT 3 and androgen receptor signaling. Int J Oncol. 2007, 31: 593-600.PubMed Yang Y, Ikezoe T, Zheng Z, Taguchi H, Koeffler HP, Zhu WG: Saw Palmetto induces growth arrest and apoptosis of androgen-dependent prostate cancer LNCaP cells via inactivation of STAT 3 and androgen receptor signaling. Int J Oncol. 2007, 31: 593-600.PubMed
38.
go back to reference Breu W, Hagenlocher M, Redl K, Tittel G, Stadler F, Wagner H: Anti-inflammatory activity of sabal fruit extracts prepared with supercritical carbon dioxide. In vitro antagonists of cyclooxygenase and 5-lipoxygenase metabolism. Arzneimittelforschung. 1992, 42: 547-551.PubMed Breu W, Hagenlocher M, Redl K, Tittel G, Stadler F, Wagner H: Anti-inflammatory activity of sabal fruit extracts prepared with supercritical carbon dioxide. In vitro antagonists of cyclooxygenase and 5-lipoxygenase metabolism. Arzneimittelforschung. 1992, 42: 547-551.PubMed
39.
go back to reference Duborija-Kovacevic N, Jakovljevic V, Sabo A, Tomic Z, Pajovic B, Perovic D: Tolerability and toxicity of lipidosterolic extract of American dwarf palm Serenoa repens in Wistar rats: well-known extract, new insight. Eur Rev Med Pharmacol Sci. 2011, 15: 1311-1317.PubMed Duborija-Kovacevic N, Jakovljevic V, Sabo A, Tomic Z, Pajovic B, Perovic D: Tolerability and toxicity of lipidosterolic extract of American dwarf palm Serenoa repens in Wistar rats: well-known extract, new insight. Eur Rev Med Pharmacol Sci. 2011, 15: 1311-1317.PubMed
40.
go back to reference Borovskaya TG, Fomina TI, Ermolaeva LA, Vychuzhanina AV, Pakhomova AV, Poluektova ME, Shchemerova YA: Comparative evaluation of the efficiency of prostatotropic agents of natural origin in experimental benign prostatic hyperplasia. Bull Exp Biol Med. 2013, 155: 67-70.CrossRefPubMed Borovskaya TG, Fomina TI, Ermolaeva LA, Vychuzhanina AV, Pakhomova AV, Poluektova ME, Shchemerova YA: Comparative evaluation of the efficiency of prostatotropic agents of natural origin in experimental benign prostatic hyperplasia. Bull Exp Biol Med. 2013, 155: 67-70.CrossRefPubMed
41.
go back to reference Coulson S, Rao A, Beck SL, Steels E, Gramotnev H, Vitetta L: A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Compl Ther Med. 2013, 21: 172-179.CrossRef Coulson S, Rao A, Beck SL, Steels E, Gramotnev H, Vitetta L: A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Compl Ther Med. 2013, 21: 172-179.CrossRef
42.
go back to reference Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T: Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of “FLOG” (flogosis and Profluss in prostatic and genital disease), a multicentre italian study. Int Braz J Urol. 2013, 39: 214-221.PubMed Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T: Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of “FLOG” (flogosis and Profluss in prostatic and genital disease), a multicentre italian study. Int Braz J Urol. 2013, 39: 214-221.PubMed
43.
go back to reference Minutoli L, Altavilla D, Marini H, Rinaldi M, Irrera N, Pizzino G, Bitto A, Arena S, Cimino S, Squadrito F, Russo GI, Morgia G: Inhibitors of apoptosis proteins in experimental benign prostatic hyperplasia: effects of Serenoa repens, selenium and lycopene. J Biomedical Sci. 2014, 21: 19-CrossRef Minutoli L, Altavilla D, Marini H, Rinaldi M, Irrera N, Pizzino G, Bitto A, Arena S, Cimino S, Squadrito F, Russo GI, Morgia G: Inhibitors of apoptosis proteins in experimental benign prostatic hyperplasia: effects of Serenoa repens, selenium and lycopene. J Biomedical Sci. 2014, 21: 19-CrossRef
Metadata
Title
Modern extraction techniques and their impact on the pharmacological profile of Serenoa repens extracts for the treatment of lower urinary tract symptoms
Authors
Celeste De Monte
Simone Carradori
Arianna Granese
Giovanni Battista Di Pierro
Costantino Leonardo
Cosimo De Nunzio
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2014
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/1471-2490-14-63

Other articles of this Issue 1/2014

BMC Urology 1/2014 Go to the issue