Benign Prostatic Hyperplasia

Lifestyle modifications

INTRODUCTION

  • Lifestyle modifications and behavioral interventions are the first line treatments of BPH (7)
  • The main goal is to improve lower urinary tract symptoms
  • Limitation of fluids at night, timed and complete voiding, treatment of constipation may help reduce symptoms (1)

NUTRITION

  • Limiting mild diuretics such as caffeine and alcohol may be beneficial (1)
  • Limiting intake of bladder irritants such as highly seasoned foods and other bladder irritating foods (7)
  • Limited evidence shows that a history of high protein intake is associated with LUTS deterioration (2)
  • Pumpkin seed soft extract: Limited evidence suggests that pumpkin seed extract may reduce symptoms of BPH (4)
  • Saw palmetto: Not recommended by UpToDate.  However, limited evidence suggests that Saw palmetto may reduce symptoms of BPH (5, 6). The latter meta analysis (6) showed very low or no clinical effect. However, it was according to ref. 4 based on studies with immense variability regarding essential  features. The small number of patients resulted in significant  imbalances in baseline IPSS with up to a 2.9-points difference between the treatment groups in 4 out of the 5 studies (see ref. 4).

PHYSICAL ACTIVITY

  • Increase physical activity and also include high intensity exercise (7)
  • Limited evidence shows that a history of low physical activity level is associated with deterioration of LUTS symptoms (3,2)

WEIGHT

  • There is some evidence that high waist circumference or BMI increases the risk of LUTS / BPH (3)

SMOKING

  • Limited evidence shows that a history of heavy smoking is associated with LUTS deterioration (2)

References

1) https://bestpractice.bmj.com/topics/en-gb/208/management-approach

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582093/

3) https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-022-03722-y

4) https://link.springer.com/article/10.1186/s40816-022-00345-0

5) https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.14362

6) https://www.eu-focus.europeanurology.com/article/S2405-4569(20)30018-3/fulltext

7) https://www.uptodate.com/contents/medical-treatment-of-benign-prostatic-hyperplasia

8) https://www.uptodate.com/contents/clinical-use-of-saw-palmetto


Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font