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Phytotherapie bei BPS

Welche Präparate können heute noch verschrieben werden?

Phytotherapy for BPS

Which products can still be prescribed?

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Zusammenfassung

Pflanzenextrakte zählen seit Jahrzehnten zu den populärsten Präparaten zur Therapie des benignen Prostatasyndroms (BPS). Nur wenige der zahlreichen Studien mit Phytopräparaten entsprechen den WHO-Standards. Die wenigen, placebokontrollierten Langzeitstudien (Studiendauer ≥6 Monate) suggerieren einen positiven Effekt mancher Extrakte (Serenoa repens, β-Sitosterole, Brennessel, Kürbissamen, Sabal-Urtica-Kombination) auf die untere Harntraktsymptomatik, ein Effekt auf Harnflussrate, Restharn, Prostatavolumen und PSA war konsistent nie nachweisbar.

Studien gegen einen aktiven Komparator (α1-Blocker oder 5α-Reduktaseinhibitor) sind nur bedingt aussagekräftig. In Ermangelung kontrollierter Studien wurden mehrere Metaanalysen publiziert, die jedoch prospektive Einzelstudien nicht ersetzten können.

Keine BPH-Leitlinie empfiehlt derzeit uneingeschränkt den Einsatz dieser Präparate zur Therapie des BPS. Sie betonen jedoch, dass es sich um einen interessanten Therapieansatz handelt. Weitere Studien nach WHO-Kriterien sind erforderlich, um die Wertigkeit von Phytopräparaten zur Therapie des BPS definitiv beurteilen zu können.

Abstract

For decades, plant extracts have been amongst to the most popular drugs for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH)/benign prostatic enlargement (BPE). Only a few of the many published studies meet the criteria of the WHO-BPH consensus conference. The few placebo-controlled, long-term (≥6 months) studies suggest a positive effect of some extracts (saw palmetto, β-sitosterol, urtica, rye-grass, saw palmetto/urtica combination) on LUTS; an effect on uroflow, post-void residual volume, prostate volume and PSA was not consistently demonstrable. Randomised trials against an active comparator (α1-blocker, 5α-reductase inhibitors) are difficult to interpret. Due to the lack of prospective studies, several meta-analyses have been published that can not, however, replace prospective studies. None of the BPH-guidelines currently recommend plant extracts, yet universally conclude that this is an interesting approach. Further prospective studies using WHO standards are required to reliably determine the role of such extracts in the management of elderly men with LUTS due to BPH/BPE.

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Authors and Affiliations

  1. Abteilung für Urologie und Andrologie, Donauspital, Wien, Österreich

    S. Madersbacher & C. Brössner

  2. Klinik für Urologie, Medizinische Universität Wien, Österreich

    G. Schatzl

  3. Urologische Klinik, Klinikum Bremen-Mitte GmbH, Bremen

    K. Dreikorn

  4. Abteilung für Urologie und Andrologie, Donauspital, Langobardenstraße 122, 1220, Wien, Österreich

    S. Madersbacher

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  1. S. Madersbacher
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  2. G. Schatzl
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  3. C. Brössner
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  4. K. Dreikorn
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Correspondence to S. Madersbacher.

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Madersbacher, S., Schatzl, G., Brössner, C. et al. Phytotherapie bei BPS. Urologe [A] 44, 513–520 (2005). https://doi.org/10.1007/s00120-005-0778-8

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