Benign Prostatic Hyperplasia

INTRODUCTION

• Lifestyle modifications and behavioral interventions are first line treatment 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/non 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. Include also strenous activity (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 increase the risk of LUTS / BPH (3)

SMOKING

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