The role of phytotherapy in treating lower urinary tract symptoms and benign prostatic hyperplasia.

Despite their traditional popularity in many European countries and their increasing use as dietary supplements in the United States, the role of phytotherapeutic agents in treating lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) is continuously debated. If strict criteria of evidence-based medicine are applied, the available data have not yet provided clear evidence of efficacy for most phytotherapeutic preparations. Different extraction procedures used by the different manufacturers, the variations of the raw products (plants) used and the fact that the potentially active component(s) of the final product and its (their) mechanism(s) of action are still under investigation make comparisons between the various products impossible. Thus, one product might have clinical efficacy while another might not. Therefore, as long as the composition of the final product of the various preparations is not proven to be identical, each manufacturer's preparation must be evaluated separately, using the gold standard of placebo-controlled studies according to accepted guidelines. Conclusions of meta-analyses that include products from different plants undergoing different extraction procedures and that are used in different dosages may be misleading. A number of short-term randomised trials and some metaanalyses in the recent literature suggest clinical efficacy and good tolerability for some preparations, mainly extracts from Serenoa repens and also Pygeum africanum, products with high concentrations of beta-sitosterol, and pumpkin seeds. It is also claimed that the efficacy of an extract from S. repens is comparable to that of finasteride and alpha-blockers. However, as has been demanded by the International Consultations on BPH, additional randomised, placebo-controlled trials are needed before phytotherapeutic agents can be recommended as an effective option in treating LUTS and BPH.