Does Voiding in a Standing Position Cause Benign Prostate Hyperplasia?

Background: Benign prostate hyperplasia (BPH) is a common health problem amongst men worldwide. It has a multifactorial ethiology, and in some societies, urinating in a standing position is believed to cause BPH. Although the effect of urination position on voiding parameters has been extensively investigated, whether they have a role in the aetiology of BPH is not known.

Material and methods: The patients who had (n = 89) and had not ever used (n = 213) alpha-blockers were included in the study. All patients were divided into four groups in accordance with their past urination habits: Group 1 (I always pee in a standing position), group 2 (I mostly pee in a standing position), group 3 (I mostly pee in a sitting position) and group 4 (I always pee in a sitting position). The current uroflowmetry results, prostate volumes (PVs) and International Prostate Symptom Score (IPSS) of the groups were compared.

Results: The IPSSs of groups 1-4 (total n = 213) who had not used alpha-blockers before were 10 (9-16), 10 (7-14), 10 (7-14) and 10 (8-13) points, respectively; Their median PVs were 40, 35, 40 and 40 mL, respectively; And their average maximum urinary flow rate (Qmax) values were 17 (12.7-20.5), 1.46 (11.1-20), 15 (12.4-18.9) and 15.6 (11.7-19.5) mL/s, respectively. No statistical difference was observed between the groups. Alpha-blockers were started in 104 patients who had not used alpha-blockers before in accordance with their clinical results. When these 104 patients who were started on alpha-blockers for the first time and 89 patients who were started on alpha-blockers before were examined together, the average ages of starting alpha-blockers were 59.9 ± 7.1, 60.5 ± 6.7, 59.6 ± 6.5 and 60.8 ± 6.7 years. No statistical difference was observed between the groups. Patients with and without clinical BPH were compared in terms of past urination habits. In both groups, the rates of patients who always or mostly urinated whilst sitting (60%-61%) and those of patients who always or mostly urinated whilst standing (39%-40%) were similar.

Conclusions: This retrospective study showed that positional urination habits do not have a role in the aetiology of BPH. However, multicentre prospective studies with a larger patient population are needed.