Exosomes in Benign Urological Disorders: From Molecular Biology to Clinical Perspectives

Exosomes, nanoscale extracellular vesicles released by virtually all cell types, have emerged as pivotal mediators of intercellular communication and play a crucial role in the pathophysiology of numerous acute and chronic diseases, including a wide spectrum of urological disorders. By acting as sophisticated biological shuttles, exosomes transport a rich and highly specific molecular cargo-comprising proteins, lipids, messenger RNAs, microRNAs, and other nucleic acids-that reflects the physiological or pathological state of their cell of origin. Owing to these unique properties, exosomes are increasingly recognized as promising biomarkers for the diagnosis, prognosis, and monitoring of a broad range of inflammatory, degenerative, and neoplastic diseases. Beyond their diagnostic value, exosomes have attracted considerable attention as therapeutic tools, given their ability to promote tissue regeneration, modulate immune responses, and serve as potential targeted drug-delivery systems for small molecules, biologics, vaccines, and gene-based therapies. Notably, exosomes recapitulate many of the beneficial biological effects traditionally attributed to stem cells, while potentially offering a more practical alternative. As cell-free entities, they may reduce-though not entirely eliminate-several risks associated with cell transplantation, such as uncontrolled proliferation and immune rejection, and they raise fewer ethical concerns, making them attractive candidates for regenerative and precision medicine. In urology, the diagnostic, prognostic, and therapeutic applications of exosomes are rapidly expanding, with particularly promising advances observed in bladder, prostate, and kidney diseases. Growing evidence also supports their relevance in a variety of benign urological conditions, including erectile dysfunction, male infertility, neurogenic bladder, urethral stricture disease, stress urinary incontinence, and bladder pain syndrome. This review synthesizes contemporary knowledge on the biological significance and clinical potential of exosomes in urology, highlighting their emerging role as biomarkers and therapeutics, with a special focus on benign urological disorders. We emphasize that the current evidence base in benign urology is largely preclinical, and that clinical translation, although promising, remains at an early stage.