[Phytotherapy for BPS. Which products can still be prescribed?].

Area of Science:

• Phytotherapy
• Urology
• Pharmacognosy

Context:

• Plant extracts are widely used for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
• Existing research often lacks methodological rigor, with few studies meeting WHO-BPH consensus criteria.
• Long-term, placebo-controlled trials suggest benefits for certain extracts on LUTS, but not consistently on objective parameters like uroflow or prostate volume.

Purpose:

• To evaluate the current evidence for plant extracts in managing LUTS due to BPH/BPE.
• To identify which plant extracts have demonstrated efficacy in clinical studies.
• To highlight the limitations of existing research and the need for further investigation.

Summary:

• Limited high-quality studies exist, but some placebo-controlled trials indicate positive effects of saw palmetto, beta-sitosterol, urtica, and rye-grass extracts on LUTS.
• Objective measures such as uroflow, post-void residual volume, prostate volume, and PSA levels were not consistently improved by these extracts.
• Randomized trials comparing plant extracts to active treatments (alpha1-blockers, 5alpha-reductase inhibitors) are difficult to interpret, and meta-analyses cannot replace prospective studies.

Impact:

• Current BPH guidelines do not recommend plant extracts, despite acknowledging their potential.
• Further prospective studies adhering to WHO standards are crucial for determining the definitive role of plant extracts in managing BPH-related LUTS in elderly men.
• This research underscores the need for robust clinical trials to validate the use of phytotherapeutics in urological practice.