Urinary Symptoms and Flow Measures

africanum improved specific urinary symptoms and flow measures. In six double-blind trials involving 430 participants, men receiving P. africanum were more than twice as likely to be rated by their physician as having overall improvement in symptoms compared with men taking placebo. P. africanum reduced nocturia compared with placebo. P. africanum also increased peak urine flow compared with placebo. Additionally, P. africanum reduced residual urine volume. 

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The evidence suggests that non-glucosidic jS-sito-sterols improve urinary symptoms and flow measures. Their long-term effectiveness, safety and ability to prevent BPH complications are not known (see Wiltetal., 2002). 

Saw palmetto relieves urinary symptoms and flow measures associated with an enlarged prostate it does not reduce the enlargement. Saw palmetto is chiefly employed to manage prostatic enlargement or benign prostatic hyperplasia (BPH). A hexane extract inhibits 5-alpha reductase, the enzyme needed for the conversion of testosterone into dihydrotestosterone (DHT). Saw palmetto further antagonizes DHT binding at prostatic receptor sites, which increases the metabolism and excretion of DHT. It is also used to treat BPH-related inflammation (see Chapter 55). 

A systematic review and meta-analysis of randomized trials of S. repens in men with benign prostatic hyperplasia showed that saw palmetto extracts improve urinary symptoms and flow measures to a greater extent than placebo, and similar improvements in urinary symptoms and flow measures to the 5-alpha-reductase inhibitor finasteride with fewer adverse effects (6). 

Despite the differences between these studies, the weight of evidence suggests that saw palmetto may induce mild to moderate improvements in urinary symptoms and flow measures. 

In a systematic review of seven double-blind placebo-controlled trials, saw palmetto was found to be significantly more effective than placebo in reducing nocturnal urinary frequency (33-74% versus 13-39%, respectively), in reducing daytime urinary frequency (11-43% versus 1-29%, respectively), and in increasing peak urinary flow (26-50% versus 2-35%, respectively). A recent meta-analysis of randomized controlled trials also indicated a therapeutic advantage of saw palmetto over placebo in improving urologic symptoms and flow measures. 

Although most previous randomized trials of saw palmetto have reported small improvements in the symptoms of BPH or in urinary flow rates, these studies were limited by the small numbers of subjects enrolled, their short duration, failure to use standardized products, their failure to use standard outcome measures, and the lack of information from participants concerning how effectively the placebo was blinded. Using widely accepted outcome measures from the American Urological Association (AUA) and a matched placebo capsule, a randomized, 1-year, double-blind saw palmetto trial (funded by the National Institutes of Health National Institute on Complementary and Alternative Medicine) was performed to determine the efficacy of saw palmetto for the treatment of BPH (111) A total of 225 men aged... 

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