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Whether a man stands or sits to urinate has no bearing on the development of benign prostate hyperplasia, according to a recent retrospective study.

Whether a man stands or sits to urinate has no bearing on the development of benign prostate hyperplasia (BPH), according to a study published in Archivos Españoles de Urología.

“Urination position varies geographically and culturally. Whilst the standing position is mostly common in Western countries, the sitting or squatting position is more common in Eastern and Asian countries,” explained corresponding author Emre Aykanli, MD, and study coauthors. “In some Eastern societies, urinating in a standing position is believed to cause BPH.”

The investigators further noted that the role of urination position in the etiology of BPH “is not known.”

Urination Habits

To investigate this question, researchers conducted a retrospective study of 302 men aged over 40 years, with and without clinical BPH, from an outpatient urology clinic in Turkey. All participants resided in the same geographic region and shared comparable dietary patterns and sociocultural backgrounds. Individuals with comorbidities known to affect voiding habits were excluded. Each participant underwent urinalysis, urinary ultrasonography, and uroflowmetric evaluation. Based on their self‑reported voiding preferences, patients were stratified into four groups:

1. “I always pee in a standing position.”
2. “I mostly pee in a standing position.”
3. “I mostly pee in a sitting position.”
4. “I always pee in a sitting position.”

Subsequently, the investigators compared the groups’ uroflowmetric parameters, prostate volumes, and International Prostate Symptom Scores (IPSS).

Among the cohort, 213 patients had never received alpha‑blocker therapy at baseline. Within this subset, the mean IPSS was 10 across all four habit groups. Median prostate volumes measured 40 mL in Groups 1, 3, and 4, and 35 mL in Group 2. Average maximum urinary flow rates (Qmax) were 17 mL/s, 11.4 mL/s, 15 mL/s, and 15.6 mL/s for Groups 1 through 4, respectively. Statistical analysis revealed no significant intergroup differences.

Of these 213 men, 104 met the diagnostic criteria for BPH upon evaluation. When comparing patients with and without clinical BPH in terms of past urination habits, the proportions who always or mostly voided while sitting (60%-61%) and those who always or mostly voided while standing (39%-40%) were comparable.

Unfounded Belief

“Thus, positional urination habits do not induce the development of BPH in healthy individuals,” the authors concluded, “and the belief that urination in standing position could cause BPH … has no scientific basis.”