Background: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.Summary: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.
