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Benign Prostatic Hyperplasia

Lifestyle modifications

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)

References

Resources

Evidence Pyramid

EXPLANATION TO EVIDENCE PRESENTATION

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

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

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Evidence based on randomized controlled trials is written in plain font

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Evidence based on observational / cohort studies is written in CURSIVE

Figure: Evidence pyramid

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