Plant extracts: sense or nonsense?
OBJECTIVE
To assess the current role of plant extracts in the medical management of lower urinary tract symptoms due to benign prostatic enlargement/benign prostatic obstruction.


RESULTS
In 2006, two clinical trials meeting the WHO benign prostatic hyperplasia consensus conference criteria (randomized against placebo/standard therapy, study duration 12 months) were published. One trial compared a saw palmetto extract with placebo. This industry-independent trial published in the New England Journal of Medicine was negative, that is, this saw palmetto extract had no effect on symptoms, Qmax and postvoid residual volume. In another trial, a saw palmetto/urtica combination was compared with tamsulosin. After 12 months, the improvement of symptoms was identical in both study arms. No detailed data were presented, however, on Qmax, postvoid residual or prostate volume. The biological mechanisms of plant extracts in vivo are still unknown and the numerous metaanalyses cannot supplement high-quality prospective trials.


CONCLUSIONS
Further prospective studies according to WHO benign prostatic hyperplasia standards are required to reliably determine the role of plant extracts in contemporary lower urinary tract symptoms management and to be able to answer the question in the title: 'plant extracts: sense or nonsense?' Plant extracts are currently not recommended by the American and European Association of Urology benign prostatic hyperplasia guidelines.
Madersbacher
Stephan
S
Department of Urology and Andrology, Donauspital, Vienna, Austria. stephan.madersbacher@wienkav.at
Berger
Ingrid
I
Ponholzer
Anton
A
Marszalek
Martin
M
D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008517:Phytotherapy; D015990:Placebo Effect; D010936:Plant Extracts / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy*; D014570:Urologic Diseases / Q000188:drug therapy* / Q000209:etiology
D010936:Plant Extracts