Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies

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It meticulously examined the pathophysiology, risk factors, and clinical presentation of BPH to shed light on its profound impact on the quality of patients’ lives. The review comprehensively presented management strategies, including pharmacological and surgical interventions, emphasizing the importance of tailored or individualized treatment plans. Furthermore, it scrutinized the emergence of technologies like laser therapy and minimally invasive procedures for their efficacy and safety profiles in managing BPH. The review culminates by underscoring the imperative for ongoing research endeavors to refine therapeutic approaches and optimize outcomes for individuals grappling with BPH to pave the way for enhanced patient care and well-being." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-1555", "name": "Innovative approaches to benign prostatic hyperplasia management:..." } } ] } Home Browse Innovative approaches to benign prostatic hyperplasia management:... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Agu PC, Tusubira D and Aja PM. Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :1555 ( https://doi.org/10.12688/f1000research.160099.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Review Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] Peter Chinedu Agu https://orcid.org/0000-0003-4739-2040 1 , Deusdedit Tusubira https://orcid.org/0000-0002-4698-424X 2 , Patrick Maduabuchi Aja https://orcid.org/0009-0006-2450-9460 3,4 Peter Chinedu Agu https://orcid.org/0000-0003-4739-2040 1 , Deusdedit Tusubira https://orcid.org/0000-0002-4698-424X 2 , Patrick Maduabuchi Aja https://orcid.org/0009-0006-2450-9460 3,4 PUBLISHED 24 Dec 2024 Author details Author details 1 Department of Biochemistry, College of Science, Evangel University Akaeze, Okpoto, Ebonyi, Nigeria 2 Department of Biochemistry, Faculty of Medicine, Mbarara University of Science and Technology, Kampala, Uganda 3 Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University - Western Campus, Bushenyi, Western Region, Uganda 4 Department of Biochemistry, Faculty of Science, Ebonyi State University, Abakaliki, Ebonyi, Nigeria Peter Chinedu Agu Roles: Conceptualization, Data Curation, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Deusdedit Tusubira Roles: Data Curation, Investigation, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Patrick Maduabuchi Aja Roles: Conceptualization, Investigation, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Future of Research (FoR) collection. Abstract This review explored Benign Prostatic Hyperplasia (BPH), a prevalent condition among aging males to elucidate its multifaceted nature and emerging treatment options. It meticulously examined the pathophysiology, risk factors, and clinical presentation of BPH to shed light on its profound impact on the quality of patients’ lives. The review comprehensively presented management strategies, including pharmacological and surgical interventions, emphasizing the importance of tailored or individualized treatment plans. Furthermore, it scrutinized the emergence of technologies like laser therapy and minimally invasive procedures for their efficacy and safety profiles in managing BPH. The review culminates by underscoring the imperative for ongoing research endeavors to refine therapeutic approaches and optimize outcomes for individuals grappling with BPH to pave the way for enhanced patient care and well-being. READ ALL READ LESS Keywords Benign Prostatic Hyperplasia (BPH), Management Strategies, Emerging Technologies, Quality of Life, Personalized Treatment. Corresponding Author(s) Patrick Maduabuchi Aja ( [email protected] ) Close Corresponding author: Patrick Maduabuchi Aja Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Agu PC et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Agu PC, Tusubira D and Aja PM. Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :1555 ( https://doi.org/10.12688/f1000research.160099.1 ) First published: 24 Dec 2024, 13 :1555 ( https://doi.org/10.12688/f1000research.160099.1 ) Latest published: 24 Dec 2024, 13 :1555 ( https://doi.org/10.12688/f1000research.160099.1 ) 1. Introduction A common ailment that primarily affects men, especially as they age, is benign prostatic hyperplasia, or BPH. A noncancerous enlargement of the prostate gland is indicative of this disorder. Some LUTS (lower urinary tract symptoms) that may result from it include the necessity to urinate more frequently, more urgently, at night, and difficulty urinating. 1 , 2 The substantially reduced quality of life caused by these symptoms emphasizes the urgent need for thorough and efficient management techniques. 3 The primary methods of treating BPH have been laser treatment, TURP (transurethral resection of the prostate), and drugs such as 5-α-reductase inhibitors and α-blockers. 4 Studies have subtly shown that these interventions enhance urine flow and reduce symptoms. But they do have some drawbacks. 5 Pharmacological therapies can have adverse effects such as weariness, dizziness, and sexual dysfunction and frequently call for long-term adherence. 6 Although surgical procedures are effective, they have risks, including the possibility of infection, bleeding, and consequences such as retrograde ejaculation. 7 Recent pieces of literature highlight the emergence of novel therapeutic strategies aimed at addressing the shortcomings of conventional treatments. 8 For instance, advances in less bellicose surgical techniques, such as the Rezum Water Vapor Therapy together with the UroLift System, have drawn a lot of interest since they relieve symptoms more effectively than standard surgery while requiring less downtime and having fewer adverse effects. 9 Scientists are also looking into new drugs, such as selective androgen receptor modulators and novel enzyme inhibitors. These drugs have shown promise in clinical trials for shrinking the prostate, making symptoms better, and maybe even lowering the risk of side effects. 10 Personalized medicine is a fascinating field that is transforming the management of BPH by customizing medicines to each patient’s unique profile using genetic, genomic, and phenotypic data. 11 Studies suggest that personalized treatment plans can significantly enhance efficacy and minimize side effects, leading to better patient outcomes. 12 For example, genetic markers associated with BPH progression can help predict which patients will benefit most from specific treatments. 13 Similarly, holistic and integrative approaches are also gaining traction in the existing pieces of literature as complementary strategies in BPH management. 14 For instance, studies have shown that lifestyle modifications such as weight management, dietary adjustments, and physical activity positively impact BPH symptoms. 15 Additionally, researchers are investigating complementary therapies like phytotherapy, acupuncture, and other alternative treatments for their potential benefits in symptom management and overall health improvement. 16 Again, managing complications and comorbidities associated with BPH is crucial, as these can exacerbate symptoms and complicate treatment. Research stresses the importance of addressing conditions like bladder dysfunction and urinary tract infections concurrently with BPH to optimize patient care. 17 Specifically, patient-centered care remains a cornerstone of effective BPH management. 18 Generally, emerging research emphasizes the value of involving patients in their treatment decisions, providing education on their condition, and maintaining open communication between healthcare providers and patients. Hence, the tools for assessing patient quality of life and satisfaction with treatment are essential for guiding management decisions and improving outcomes. Future directions in BPH care are being shaped by ongoing research and technology improvements. 19 To improve diagnosis, therapy, and patient monitoring, emerging research focuses on novel biomarkers, creative therapeutic modalities, and the incorporation of digital health technology. 20 Unintentionally, the body of current research on benign prostatic hyperplasia management reveals a dynamic and changing field. 21 – 23 Therefore, going beyond conventional medications, new research emphasizes the potential for personalized medicine, innovative therapeutics, and holistic ways to deliver more efficient and patient-centered care. 24 This chapter suggests that BPH management requires a multimodal strategy to enhance patient outcomes and quality of life. 2. Understanding benign prostatic hyperplasia 2.1 Pathophysiology and epidemiology The non-cancerous widening of the prostate gland, which typically affects elderly men, is the hallmark of BPH. The prostate’s stromal and epithelial cell proliferation is a pathology of benign prostate hyperplasia (BPH), resulting in the formation of big, characteristic nodules in the vicinity of the urethra. 25 The symptoms of BPH are brought on by these nodules compressing the urethral canal, which can restrict the urethra partially or completely. 26 Hormonal changes that cause the prostate to grow, such as elevated levels of estrogen and DHT, 27 , 28 inflammation, and genetic predisposition all play important roles in the development of BPH. 29 Epidemiological studies reveal that BPH is a common condition in aging men to distress approximately 50% of those between the ages of 51 and 60 and up to 90% of those over 80. 30 Because of its increasing prevalence and severity with age, BPH is a serious health concern that greatly affects the quality of life and should be discerned from benign prostatic enlargement (BPE) and lacunculation (LUTS), the latter of which frequently necessitates medical consultation. 30 The IPSS (International Prostate Symptom Score) or the AUA (American Urological Association) symptom score is commonly used to measure the symptoms of LUTS, which include urge, frequency, nocturia, urgency, and dribbling after voiding. In older men, urodynamic changes such as benign prostatic hindrance and overactive or hypoactive detrusor muscles are the main causes of LUTS. The prevalence of BPH, BPE, and LUTS increases with age, with moderate to severe LUTS affecting roughly 20% of men in their 50s, 30% in their 60s, and 40% in their 80s. 31 In Austria, it is estimated that approximately 350,000 men over 40 currently experience moderate to severe LUTS, a number expected to rise to around 500,000 in the next two decades due to demographic changes. 1 , 2 Despite its high prevalence and socioeconomic impact, the complete pathophysiology of BPH remains poorly understood, particularly why some men develop significantly larger prostates than others. 32 Visibly, the mechanisms leading to LUTS are complex, involving various urodynamic patterns, changes in the bladder and urothelium, anticholinergic receptor status, and pelvic ischemia, highlighting the need for further research to develop effective treatments. 1 , 33 2.2 Symptoms and clinical presentation Although BPH can manifest clinically in a variety of ways, lower urinary tract symptoms (LUTS) are generally linked to it. 2 LUTS are classified into three main categories by the International Continence Society (ICS): storage symptoms (affecting the bladder’s ability to store urine), voiding symptoms (difficulties in the bladder emptying process), and post-micturition symptoms (leakage after urination). 34 These symptoms shown in Table 1 can significantly impact a person’s quality of life, and addressing them with medical consultation is essential for proper management and relief. Table 1. Symptoms and clinical presentations of main categories of BPH. a. Storage symptoms and clinical manifestations Increased daytime frequency Frequent urination can disrupt daily activities and lead to discomfort and inconvenience. Nocturia Disrupted sleep, leads to fatigue, and can affect overall quality of life. Urgency This can lead to anxiety and rushing to the bathroom, which can be particularly challenging in public or social situations. Urinary incontinence Leakage occurs with physical activity or exertion, such as coughing, sneezing, or lifting. Also, leakage occurs due to bladder overfilling and not emptying properly. b. Voiding symptoms and clinical manifestations Hesitancy Delays in the start of urination can cause frustration and discomfort. Slow stream Prolonged time to urinate, which can be bothersome and inconvenient. Intermittency The flow of urine is not continuous, leading to a prolonged and incomplete feeling of urination. Straining Physical exertion needed to urinate can be tiring and uncomfortable, potentially leading to other issues like hernias. Terminal dribble This occurs as lingering in the bathroom to ensure the bladder is empty, leading to inconvenience and potential hygiene issues. c. Post-micturition symptoms and clinical manifestations Post-micturition dribble Leakage can cause wetness and discomfort in clothing, requiring frequent changes and impacting quality of life. A feeling of incomplete emptying Persistent feeling of needing to urinate again soon after finishing, leading to frequent bathroom visits and discomfort. 2.3 Risk factors and demographic influences Several risk factors have been identified for the development of BPH. 35 These risk factors are outlined in Figure 1 . Figure 1. Outline of the risk factors of BPH. The main risk factor for BPH is age, as men age, and as a result, the frequency and intensity of symptoms both rise significantly. 36 Hormonal factors further exacerbate this, as androgens such as dihydrotestosterone (DHT) are critical for prostatic growth. 29 A further factor contributing to the illness may be an imbalance in the levels of estrogen and testosterone. Another factor is genetics; a family history of BPH raises the risk, suggesting a genetic predisposition; certain genetic markers have been shown to enhance the risk of developing BPH. 37 Furthermore, there is a considerable correlation between insulin resistance, obesity, hypertension, dyslipidemia, and other elements of metabolic syndrome and BPH, indicating the impact of general metabolic health on prostate enlargement. 18 Moreover, lifestyle variables can have a major impact on the risk of BPH. 38 A higher incidence of BPH is associated with diets high in fat and red meat and low in fruits and vegetables; nevertheless, regular physical activity seems to offer a preventive effect. Studies reveal that African-American males are more prone than Caucasian men to acquire and have more severe types of BPH. Ethnicity also affects the prevalence and severity of BPH. 39 Comprehending the intricate relationships among these risk factors is crucial for healthcare practitioners to formulate efficacious management approaches customized to specific patient profiles, hence enhancing patient outcomes via individualized interventions. 40 In particular, healthcare professionals can better serve their patients’ needs by addressing the various pathophysiological causes, clinical manifestations, and demographic factors linked to BPH. 2 3. Standard management approaches When treating BPH, conservative methods are usually used first, then depending on the patient’s preferences and the severity of the symptoms, more invasive techniques are eventually tried. Surgical operations, minimally invasive procedures, and pharmaceutical therapy are examples of conventional therapeutic methods that are intended to improve quality of life and relieve symptoms. 41 3.1 Pharmacological treatments As seen in Table 2 , pharmacological treatments are frequently the initial line of treatment for BPH. 42 These treatments can be broadly divided into two primary categories. Table 2. Conventional pharmacological treatments for BPH. α-Blockers Mechanism of action α-blockers act by soothing the smooth muscle in the prostate and bladder neck, thereby improving urine flow and reducing bladder vent obstruction. Common examples Tamsulosin, alfuzosin, doxazosin, and terazosin. Efficacy Α-blockers are effective in quickly relieving symptoms. Side effects Common side effects include dizziness, fatigue, and orthostatic hypotension (a depressed blood pressure when in upright position). 5-α-Reductase Inhibitors Mechanism of action These medications reduce the size of the prostate by inhibiting the alteration of testosterone to dihydrotestosterone (DHT), a hormone that promotes prostate growth Common examples Finasteride and dutasteride. Efficacy 5-α-reductase inhibitors are particularly useful in men with grander prostates and can condense the peril of acute urinary holding and the need for surgery. Side effects Side effects may include decreased libido, erectile dysfunction, and a reduction in semen volume. In pharmacological treatment, combination therapy with both α-blockers and 5-α-reductase inhibitors can be more effective than either treatment alone, especially in men with moderate to severe symptoms. 11 3.2 Surgical interventions In the current treatment regimen for BPH, patients who do not respond to pharmacological treatments or have severe symptoms sorts for surgical interventions. 43 The most common surgical options are presented in Table 3 . Table 3. Conventional surgical interventions for BPH. Transurethral Resection of the Prostate (TURP) Procedure TURP encompasses the amputation of prostate tissue through the urethra using a resectoscope. It is considered the golden standard for surgical treatment of BPH. Efficacy and recovery TURP is highly effective in relieving symptoms and taming urinary flow. The recovery period typically involves a short hospital stay and catheterization for a few days. Complications Potential complications include bleeding, infection, retrograde ejaculation (semen enters the bladder instead of exiting through the penis), and in rare cases, urinary incontinence. Laser Therapy Procedure Various types of laser therapies, such as HoLEP (Holmium Laser Enucleation of the Prostate) and PVP (Photo-selective Vaporization of the Prostate), use laser vigor to confiscate or vaporize prostate tissue. Efficacy and recovery Laser therapies are effective and have a quicker recovery time compared to TURP, with fewer complications such as bleeding. Patients typically experience immediate symptom relief. Complications Similar to TURP, potential complications include retrograde ejaculation, temporary urinary incontinence, and urethral stricture (narrowing of the urethra). 3.3 Limitations of BPH standard treatment approaches Despite the efficacy of conventional treatment options, several limitations exist ( Table 4 ). These limitations highlight the importance of exploring new and innovative treatment strategies beyond the norm for BPH that can offer better outcomes with fewer adverse effects. 11 , 42 , 43 Table 4. Limitations of conventional interventions for BPH. S/N Pharmacological treatments Surgical interventions a. Side effects: Both α-blockers and 5-α-reductase inhibitors have side effects that can affect patient compliance and quality of life. Invasiveness: Surgical procedures are invasive and carry risks such as bleeding, infection, and anesthesia-related complications. b. Variable efficacy: Not all patients respond equally to medications, and the benefits may diminish over time. Recovery time: Although modern techniques have reduced recovery times, patients still require a period of convalescence, which can be inconvenient and impact daily activities. c. Symptom management: Medications primarily manage symptoms without addressing the underlying enlargement of the prostate in the long term, except for 5-α-reductase inhibitors which can reduce prostate size. Long-term complications: Complications such as retrograde ejaculation and, in some cases, urinary incontinence can affect sexual function and overall quality of life. 4. Emerging therapeutic strategies for BPH 4.1 Novel pharmacological agents The goal of recent developments in BPH medication is to reduce adverse effects and increase efficacy. As shown in Table 5 , several new agents are being studied or were just presented. 44 , 45 Table 5. Novel pharmacological agents for BPH treatments. Selective Androgen Receptor Modulators (SARMs) Mechanism of action SARMs selectively target androgen receptors in prostate tissue, potentially offering the benefits of reducing prostate size and symptoms with fewer systemic side effects compared to traditional therapies. Efficacy Early clinical trials indicate promising results in symptom relief and prostate volume reduction. Side effects Side effects appear to be minimal, but long-term studies are needed to fully understand their safety profile. Phosphodiesterase-5 Inhibitors (PDE5-Is) Mechanism of action PDE5-Is, such as tadalafil, traditionally used for erectile dysfunction, have been shown to improve LUTS in BPH by enhancing smooth muscle slackening in the lower urinary tract. Efficacy Studies suggest that PDE5-Is can improve both urinary symptoms and sexual function, providing a dual benefit for patients Side effects Common side effects include headache, indigestion, and back pain. Combination Therapies Rationale Combining medications with different mechanisms of action can offer enhanced symptom relief and a comprehensive approach to managing BPH. Examples The combination of α-blockers and 5-α-reductase inhibitors is more effective than either therapy alone in reducing symptoms and the risk of BPH progression. 4.2 Minimally invasive surgical techniques Minimally invasive techniques are becoming increasingly popular due to their effectiveness and reduced recovery times compared to traditional surgery. 46 , 47 These procedures aim to relieve obstruction while minimizing tissue damage (see Table 6 ). Table 6. Highlights of minimally invasive surgical interventions for BPH. Prostatic Urethral Lift (PUL) Procedure The UroLift System encompasses the stationing of small implants that lift and grasp the enlarged prostate tissue away from the urethra to reduce hindrance without removing tissue. Efficacy and recovery Clinical studies have demonstrated significant improvement in symptoms and quality of life with a quick recovery time and minimal side effects. Most patients can return to normal activities within a few days. Complications Common side effects include temporary hematuria (blood in urine), pelvic pain, and dysuria (painful urination). Water Vapor Thermal Therapy Procedure The Rezum System uses convective water vapor vigor to ablate excess prostate tissue, thereby reducing the size of the prostate and alleviating obstruction. Efficacy and recovery Rezum therapy has shown substantial symptom improvement and prostate volume reduction. The procedure is archetypally performed under local anesthesia, and patients can resume normal activities shortly after treatment. Complications Side effects are generally mild and include urinary tract infection, hematuria, and temporary urinary retention. 4.3 Advances in BPH treatment technology Technological advancements are continuously evolving the landscape of BPH treatment, providing less invasive, more effective options with faster recovery times and fewer complications 46 , 48 (see Table 7 ). Table 7. Technologically advanced techniques for BPH treatment. Treatment techniques Technology Advantages Outcomes a. UroLift System The UroLift system uses tiny scions to hoist and hold the prostate tissue out of the way, providing an open channel for urine flow. This system offers rapid symptom relief with a low risk of sexual side effects, making it an attractive option for sexually active men. Studies have shown durable improvements in indicators and life’s quality up to five years post-procedure. b. Rezum Water Vapor Therapy Rezum uses radiofrequency-generated water vapor to induce thermal ablation of prostate tissue. This treatment is minimally invasive, can be executed in an outpatient scenery, and has shown effective symptom relief with the preservation of sexual function. Clinical trials have demonstrated significant and sustained symptom improvement with a low rate of complications. c. PAE (Prostate Artery Embolization) PAE, a minimally invasive procedure that involves the embolization of the prostatic arteries to reduce blood flow, leading to the shrinkage of the prostate. This technique is performed under local anesthesia with a high safety profile, particularly suitable for patients who are not candidates for traditional surgery. Early results are promising, showing significant symptom relief and improved life’s quality though long-term data is still being evaluated. These emerging therapeutic strategies represent significant advancements in the management of BPH. By offering effective symptom relief with fewer side effects and faster recovery times, these innovations provide patients with more options to tailor their treatment to their specific needs and preferences. 5. Personalized medicine in BPH 5.1 Role of genetic and molecular profiling Genetic and molecular profiling are revolutionizing the approach to managing BPH by providing deeper insights into the disease’s underlying mechanisms and individual patient variability. In terms of genetic profiling, researchers have identified several genetic markers associated with an increased risk of BPH. For instance, variations in genes interrelated to androgen metabolism, inflammation, and growth factor signaling have been allied to the development and progression of BPH. 25 Similarly, understanding genetic differences in drug metabolism and response can help predict which patients are prospective to benefit from specific medications. For case, dissimilarities in genes encoding enzymes fingered in drug metabolism can distress the efficacy and safety of α-blockers and 5-α-reductase inhibitors. 42 Additionally, molecular profiling can identify biomarkers that predict disease progression and response to treatment. For instance, levels of prostate-specific antigen (PSA) and other novel biomarkers can provide information about the severity of BPH and the likelihood of progression. 49 Furthermore, analysis of molecular pathways involved in BPH, such as those regulating cell proliferation, apoptosis, and inflammation, can identify potential therapeutic targets and guide the development of targeted therapies. 50 , 51 5.2 Customized treatment plans based on patient characteristics Personalized medicine encompasses tailoring treatment tactics to the individual characteristics of each patient, enhancing the effectiveness and minimizing adverse effects. 47 , 52 5.2.1 Patient characteristics Imaging studies such as ultrasound and MRI can provide detailed information about prostate size, shape, and the presence of specific anatomical features (e.g., median lobe enlargement) that may influence treatment choices. 53 Also, the IPSS and quality of life assessments help gauge the severity of symptoms and their impact on daily activities, guiding the intensity and type of treatment. 30 Overall, a comprehensive evaluation of the patient’s overall health, including the presence of comorbid conditions (e.g., cardiovascular disease, diabetes) and current medications, ensures that treatment plans are safe and effective. 52 , 54 5.2.2 Tailored therapies Based on genetic and molecular profiling, healthcare providers can choose the most suitable medications and adjust dosages to optimize efficacy and reduce side effects. 25 For instance, patients with genetic variations affecting drug metabolism may require alternative dosing strategies. Similarly, customized surgical plans take into account the patient’s prostate anatomy and inclusive health. 53 For example, minimally invasive techniques like the UroLift or Rezum might be preferred for patients with certain anatomical profiles or those who are at higher risk for surgical complications. 47 6. Holistic and integrative management 6.1 Lifestyle modifications and their impact on BPH Lifestyle modifications play a decisive role in the holistic management of BPH by potentially reducing symptoms and slowing disease progression 55 (see Table 8 ). Table 8. Highlights of lifestyle modification approaches to BPH interventions. Lifestyle modifications Their impact on BPH Weight management Obesity is connected with an increased risk and severity of BPH. Weight loss can help reduce the mechanical pressure on the bladder and improve urinary symptoms. Research indicates that weight reduction through diet and exercise can lead to significant improvements in BPH symptoms and lower urinary tract symptoms (LUTS). Physical activity Regular exercise, particularly aerobic and resistance training, has been shown to reduce the risk of BPH and alleviate symptoms. Physical activity helps improve blood circulation, reduce inflammation, and balance hormone levels, all of which can positively impact prostate health. Fluid management Limiting fluid intake in the evening can help reduce nocturia (nighttime urination). Dodging bladder irritants such as caffeine and alcohol can also aid manage urinary symptoms. 6.2 Diet and nutrition recommendations Diet and nutrition are critical components of holistic BPH management, with certain dietary patterns and nutrients associated with reduced risk and symptom relief 56 , 57 (see Table 9 ). Table 9. Highlights of diet and nutrition intervention for BPH interventions. Diet and nutrition recommendations Their impact on BPH Dietary patterns Mediterranean diet: This diet, rich in vegetables, whole grains, fruits, and healthy fats (such as olive oil), has been allied to a lower risk of BPH and improved urinary function. Low-fat diet: Reducing dietary fat, particularly from animal sources, may help decrease prostate size and symptoms. Specific nutrients Lycopene: Found in tomatoes and other red fruits, lycopene is an antioxidant that has been shown to lower the risk of BPH and prostate cancer. Zinc: Adequate zinc intake, found in foods like shellfish, seeds, and nuts, is essential for prostate health and may reduce BPH symptoms. Omega-3 fatty acids: Found in fatty fish (e.g., mackerel, salmon), these fatty acids have anti-inflammatory properties that can benefit prostate health. Plant sterols: Beta-sitosterol, a plant sterol found in foods such as nuts and seeds, has been shown to recover urinary symptoms allied with BPH. Avoiding processed foods Recommendations: Reducing the intake of processed foods high in sugar, salt, and unhealthy fats can help manage weight and inflammation, contributing to better prostate health. 6.3 Complementary and alternative therapies Complementary and alternative therapies can offer additional relief for BPH symptoms and improve overall well-being 58 (see Table 10 ). Table 10. Highlights of complementary and alternative therapies for BPH. Complementary and alternative therapies Their impact on BPH Herbal Supplements Saw palmetto: Widely used for BPH, saw palmetto is believed to reduce prostate size and improve urinary symptoms. Some studies show mixed results, but it remains a popular option. Pygeum africanum: The extract from the African plum’s tree have been shown to reduce BPH symptoms, including urinary frequency and nighttime urination. Stinging Nettle : Often used in combination with other herbs, stinging nettle can help relieve urinary symptoms together with life’s quality improvement. Acupuncture Efficacy: Acupuncture has been studied for its potential to alleviate LUTS associated with BPH. Some research indicates that acupuncture can improve urinary flow rates and reduce symptoms. Mechanism: It is believed that acupuncture works by improving blood flow, reducing inflammation, and balancing the autonomic nervous system. Phytotherapy Combination herbal formulas: Various formulations combining different herbs (e.g., saw palmetto, pygeum, stinging nettle) are used to target multiple aspects of BPH pathology. Evidence: While some clinical trials show positive effects, more rigorous research is needed to standardize these treatments and confirm their efficacy. Mind-Body Practices Yoga and Tai Chi: These practices promote relaxation, reduce stress, and improve overall physical fitness, which can indirectly benefit prostate health and reduce BPH symptoms. Stress Management: Techniques such as deep breathing, meditation, and exercises can help switch stress, which may otherwise exacerbate BPH symptoms. Integrating these holistic and alternative approaches with conventional medical treatments can provide a comprehensive management strategy for BPH, addressing not only the physical symptoms but also enhancing overall health and quality of life. 7. Addressing complications and comorbidities 7.1 Managing associated conditions 7.1.1 Bladder dysfunction Proper assessment of bladder dysfunction in BPH patients is critical. Urodynamic studies can diagnose the type and extent of bladder issues, such as detrusor overactivity or impaired contractility. Management involves behavioral therapies like bladder training and pelvic floor muscle exercises, which can improve bladder control. Medications, including antimuscarinics or beta-3 agonists, may be prescribed to manage overactive bladder symptoms, reducing urgency, frequency, and incontinence episodes. For severe bladder dysfunction, surgical interventions such as bladder neck incision or augmentation cystoplasty might be necessary. 59 , 60 7.1.2 Urinary tract infections (UTIs) According to Fisher et al. , 60 preventing UTIs involves maintaining good hydration and proper hygiene. In recurrent cases, prophylactic antibiotics may be used as treatment requires appropriate antibiotic therapy based on culture and sensitivity results, with long-term low-dose antibiotics considered for recurrent UTIs. 61 Also, if chronic prostatitis is suspected, longer courses of antibiotics targeting prostate tissue may be necessary. 62 7.2.3 Chronic kidney disease (CKD) Regular nursing of renal function through blood tests (e.g., estimated glomerular filtration rate and serum creatinine) and urine analysis is essential. 63 Managing CKD involves addressing the underlying cause of urinary obstruction and ensuring proper urinary drainage to prevent further kidney damage. Referral to a nephrologist for comprehensive management of CKD and associated conditions may be required. 64 7.2 Strategies for dealing with treatment-resistant BPH 7.2.1 Reassessment and diagnosis For treatment-resistant BPH, a detailed evaluation of the patient’s symptoms, imaging studies (e.g., transrectal ultrasound, MRI), and urodynamic testing can help understand the resistance to treatment. Identifying contributing factors, such as bladder stones, strictures, or neurogenic bladder, is essential for targeted management. 53 7.2.2 Advanced pharmacotherapy Combination therapy with α-blockers and 5-α-reductase inhibitors may maximize symptom relief. Therefore, exploring alternative medications, such as PDE5 inhibitors (e.g., tadalafil), or off-label uses like botulinum toxin injections into the prostate or bladder, can also be considered. 65 7.2.3 Minimally invasive procedures Prostatic Artery Embolization (PAE) is a non-surgical option that reduces prostate volume by decreasing its blood supply. Consequently, Convective Water Vapor Therapy (Rezum) uses thermal energy to ablate excess prostate tissue, effective in treatment-resistant cases. 66 7.2.4 Surgical interventions Holmium Laser Enucleation of the Prostate (HoLEP) is effective for larger prostates and provides long-term symptom relief. Hence, Open or robot-assisted simple prostatectomy is considered for very large prostates where minimally invasive techniques may not be effective. 67 7.3 Post-treatment follow-up and monitoring 7.3.1 Regular follow-up visits Initially, frequent visits (e.g., every 3-6 months) post-treatment are necessary to monitor recovery and response, gradually reducing to annual check-ups if stable. Therefore, a comprehensive evaluation using the IPSS, physical examination, and PSA testing if indicated is essential. 34 7.3.2 Monitoring for complications Immediately post-treatment, monitoring for signs of bleeding, infection, and urinary retention is critical, ensuring proper catheter care if used. So, long-term hitches, such as bladder neck contractures, urethral strictures, or recurrent BPH, should also be watched for. 68 7.3.3 Lifestyle and health maintenance Encouraging healthy habits like weight management, regular physical activity, and a balanced diet is vital. Hence, patient education on recognizing symptoms of complications or recurrence and advising on when to seek medical attention is also important. 7.3.4 Adjunct therapies and support Referral to a physical therapist for pelvic floor exercises can improve urinary control and reduce symptoms. Hence, addressing the psychological impact of BPH and its treatment through counseling or support groups is also beneficial. 7.3.4 Coordinated care A multidisciplinary approach involving urologists, primary care physicians, physical therapists, and other specialists as needed ensures comprehensive care. Therefore, effective patient-centered communication keeps patients well-informed about their condition, treatment options, and the importance of adherence to follow-up schedules. Generally, addressing complications and comorbidities in BPH requires a multifaceted approach combining careful monitoring, advanced treatment strategies, and holistic patient care. These elements, if properly integrated can help healthcare providers enhance patient outcomes and quality of life. 8. Future perspectives and research directions The future of BPH management is poised to be revolutionized by ongoing research and technological advancements, including gene therapy targeting genetic pathways, identification of new molecular biomarkers, development of novel drug classes, and innovative drug delivery systems. 19 For example, minimally invasive techniques are expected to improve with next-generation devices and the integration of robotics and AI, while regenerative medicine, such as stem cell therapy, holds the potential for restoring healthy prostate function. 68 These advancements will facilitate personalized treatment plans and optimized drug regimens based on genetic profiling, proactive screening, and preventive strategies. Furthermore, enhanced patient outcomes will be driven by continued improvements in minimally invasive options and comprehensive care models. It is expected that future trends will emphasize prevention through lifestyle interventions and public health initiatives, technology-driven care with telemedicine and AI, holistic and integrative health models, and patient-centered care. Therefore, adapting clinical guidelines and having flexible insurance coverage will be essential to ensure that medical professionals can provide the most recent evidence-based procedures for BPH management beyond the norm. 9. Conclusion Effective management of Benign Prostatic Hyperplasia (BPH) necessitates a multifaceted approach that encompasses traditional treatments, emerging therapies, and holistic care. Intuitively, understanding BPH’s pathophysiology, symptoms, and risk factors is essential while addressing complications, and adopting personalized medicine ensures tailored treatment plans. Practically, combining conventional pharmacological and surgical options with novel minimally invasive techniques and integrative approaches such as lifestyle modifications and complementary therapies enhances patient outcomes. Also, emphasizing patient-centered care through education, involvement in decision-making, and effective communication fosters better adherence and satisfaction. In general, continued study and technical developments will change the way BPH is managed, eventually enhancing patients’ quality of life. Data availability No data are associated with this article. Acknowledgments We are grateful for the administrative support offered to us during this study by the Department of Biochemistry, College of Science, Evangel University, Akaeze, Ebonyi State, Nigeria. References 1. Ng M, Leslie SW, Baradhi KM: Benign prostatic hyperplasia. StatPearls. StatPearls Publishing; 2024. Reference Source 2. Roehrborn CG: Benign prostatic hyperplasia: An overview. Rev. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Dec 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Biochemistry, College of Science, Evangel University Akaeze, Okpoto, Ebonyi, Nigeria 2 Department of Biochemistry, Faculty of Medicine, Mbarara University of Science and Technology, Kampala, Uganda 3 Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University - Western Campus, Bushenyi, Western Region, Uganda 4 Department of Biochemistry, Faculty of Science, Ebonyi State University, Abakaliki, Ebonyi, Nigeria Peter Chinedu Agu Roles: Conceptualization, Data Curation, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Deusdedit Tusubira Roles: Data Curation, Investigation, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Patrick Maduabuchi Aja Roles: Conceptualization, Investigation, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 24 Dec 2024, 13:1555 https://doi.org/10.12688/f1000research.160099.1 Copyright © 2024 Agu PC et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Agu PC, Tusubira D and Aja PM. Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :1555 ( https://doi.org/10.12688/f1000research.160099.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 24 Dec 2024 Views 0 Cite How to cite this report: Nedbal C. Reviewer Report For: Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :1555 ( https://doi.org/10.5256/f1000research.175921.r354558 ) The direct URL for this report is: https://f1000research.com/articles/13-1555/v1#referee-response-354558 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Jan 2025 Carlotta Nedbal , Urology, Universita Politecnica delle Marche Facolta di Medicina e Chirurgia, Ancona, Marche, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.175921.r354558 Management of BPH is one of the most common interventions in urology, this review discusses the newest and uncommon treatment strategies. I have some comments: - Please use abbreviations when needed (i.e., use BPH instead of ... Continue reading READ ALL Management of BPH is one of the most common interventions in urology, this review discusses the newest and uncommon treatment strategies. I have some comments: - Please use abbreviations when needed (i.e., use BPH instead of benign prostatic hyperplasia) in all text. Only first clarification is needed. Please check that all abbreviations are declared when first mentioned. - Introduction "the Rezum Water Vapor Therapy together with the UroLift System, have drawn a lot of interest since they relieve symptoms more effectively than standard surgery". This is incorrect, studies have proven comparable symptoms relief outcomes and still need further confirmation. - "lacunculation": What does this term mean...please clarify? - Standard management approaches: the paragraph is very limited providing only summarised list of some of the current therapies, both pharmacological and surgical. Please expand it. - Emerging therapeutic strategies: again, the paragraph is very limited and does not provide any constructive and new information. New techniques are only partially included and just mentioned, with no informative content. - Addressing complications and comorbidities: this paragraph is redundant and little informative. Is the topic of the review discussed comprehensively in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Partly Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Urology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Nedbal C. Reviewer Report For: Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :1555 ( https://doi.org/10.5256/f1000research.175921.r354558 ) The direct URL for this report is: https://f1000research.com/articles/13-1555/v1#referee-response-354558 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Dec 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 24 Dec 24 read Carlotta Nedbal , Universita Politecnica delle Marche Facolta di Medicina e Chirurgia, Ancona, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Nedbal C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Jan 2025 | for Version 1 Carlotta Nedbal , Urology, Universita Politecnica delle Marche Facolta di Medicina e Chirurgia, Ancona, Marche, Italy 0 Views copyright © 2025 Nedbal C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Management of BPH is one of the most common interventions in urology, this review discusses the newest and uncommon treatment strategies. I have some comments: - Please use abbreviations when needed (i.e., use BPH instead of benign prostatic hyperplasia) in all text. Only first clarification is needed. Please check that all abbreviations are declared when first mentioned. - Introduction "the Rezum Water Vapor Therapy together with the UroLift System, have drawn a lot of interest since they relieve symptoms more effectively than standard surgery". This is incorrect, studies have proven comparable symptoms relief outcomes and still need further confirmation. - "lacunculation": What does this term mean...please clarify? - Standard management approaches: the paragraph is very limited providing only summarised list of some of the current therapies, both pharmacological and surgical. Please expand it. - Emerging therapeutic strategies: again, the paragraph is very limited and does not provide any constructive and new information. New techniques are only partially included and just mentioned, with no informative content. - Addressing complications and comorbidities: this paragraph is redundant and little informative. Is the topic of the review discussed comprehensively in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Partly Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Urology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Nedbal C. Peer Review Report For: Innovative approaches to benign prostatic hyperplasia management: Options beyond conventional treatment strategies [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :1555 ( https://doi.org/10.5256/f1000research.175921.r354558) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1555/v1#referee-response-354558 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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