Clinic of Urology and Transplantation, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany,
Department of Urology, Kaiser Franz Josef Hospital, Vienna, Austria.
Urol Int. 2020;104(5-6):333-342. doi: 10.1159/000504611. Epub 2019 Dec 18.
Practice guidelines hardly recommend herbal extracts for male lower urinary tract symptoms (LUTS). However, many patients are unsatisfied with first-line synthetic drugs and often prefer herbal medicines because of good tolerability. To improve the decision-making process, which should consider the patients' expectations, it is crucial to reflect on the role of phytotherapy in the treatment of LUTS. We (panel experts) reflected on current guideline recommendations and real practice across various European countries and debated the potential role of plant extracts with a focus on pumpkin seed soft extract investigated over 12 months in two randomised placebo-controlled trials.
Most guidelines give no clear recommendations on phytotherapy due to the heterogeneity of clinically investigated extracts. Nevertheless, plant extracts are prescribed to patients with mild-to-moderate LUTS. Also, self-medicating patients often handle their complaints with herbal products. Many patients aim to avoid synthetic drugs for fear of sexual functional side effects and a negative impact on their quality of life. For the elderly, vasoactive comedications might become an issue. When taking plant extracts, patients experience an acceptable symptomatic relief similar to that achieved with synthetics but without side effects. Key Messages: In shared decision-making for purely symptomatic treatment, a low risk of side effects takes priority. We propose to consider patient preferences in the treatment of mild-to-moderate LUTS in men with a low risk of disease progression. We found a consensus that pumpkin seed soft extract adds to the therapeutic armamentarium for patients who cannot or do not want to apply synthetic drugs.
实践指南几乎不推荐草药提取物用于男性下尿路症状（LUTS）。然而，由于良好的耐受性，许多患者对一线合成药物不满意，经常更喜欢使用草药。为了改善决策过程，应考虑患者的期望，反思植物疗法在治疗 LUTS 中的作用至关重要。我们（专家组）反思了当前的指南建议和欧洲各国的实际实践，并讨论了植物提取物的潜在作用，重点是研究了 12 个月的南瓜籽软胶囊在两项随机安慰剂对照试验中的作用。
由于临床研究的提取物具有异质性，大多数指南都没有明确推荐植物疗法。然而，植物提取物仍被开给有轻至中度 LUTS 的患者。此外，自行用药的患者常常用草药产品来处理他们的抱怨。许多患者担心性功能副作用和对生活质量的负面影响而避免使用合成药物。对于老年人，血管活性药物可能成为一个问题。当服用植物提取物时，患者会获得与合成药物相似的可接受的症状缓解，但没有副作用。
在纯粹对症治疗的共同决策中，副作用风险低优先考虑。我们建议在治疗有低疾病进展风险的男性轻至中度 LUTS 时，考虑患者的偏好。我们发现，对于不能或不愿应用合成药物的患者，南瓜籽软胶囊增加了治疗手段。
