Phytomedicines in Pharmacotherapy of LUTS/BPH - What Do Patients Think?

Lower urinary tract symptoms (LUTS) consist of voiding and storage symptoms. While the therapeutic efficacy of current LUTS medications is limited, and with more than 20% of patients suffering from mixed symptoms, current guidelines offer nothing more than combining monotherapies. An individualized approach is urgently warranted, and phytomedicines have become an integral part of patient-empowerment in therapeutic shared-decision making processes. Therefore, we aimed to investigate patients' preference of phytomedicines and treatment adherence at the dawn of an era leaving α₁-blocker monotherapies behind.

A questionnaire was prepared, and patients at our tertiary referral center were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 300 patients during their visits from January 2022 to December 2022.

With 73% (218/300), most of our study cohort had either taken one or more or were currently on prescription medication for LUTS/BPH. Patients were prescribed α₁-blockers (72%), followed by 5α-reductase inhibitors (21%), and phosphodiesterase-5-inhibitor (5%), while antimuscarinics and β₃-agonists were rarely prescribed. However, 41% (89/218) of our patients, who were taking medication for LUTS, had taken or were currently taking phytomedicines, making this the second most common drug class in our patient cohort. Patients scored the efficacy of phytomedicines at a mean in the lower third, but 87% of patients attributed excellent tolerability, and only 9% experienced side effects. While 43% of patients recommended phytomedicines for other patients, two-thirds of patients thought phytomedicines should be covered by statutory health insurance.

We found that phytomedicines were the second most common drug class taken by LUTS patients at our hospital. Reasons may be easy availability as over the counter medication and a superior safety profile with less bothersome side effects than commonly prescribed drug classes. Taken together, phytomedicines may be able to bridge an important gap in LUTS pharmacotherapy to provide sufficient treatment adherence where prescription drug classes fail, and ultimately, adequate improvement of symptoms. However, patients need to be counseled on potentially limited efficacy.