Table 2.

Summary of relevant literature examining the role of phytotherapies in treating LUTS attributable to BPH.

Name	Authors	Number of Participants	Country of Origin	Comparison Arm	Follow-Up Period	Summary of Results
Serenoa repens (Saw Palmetto)	Bent et al., 2006 [68]	225	United States	Placebo	14 months	No significant reduction in prostate volume (mean difference −1.22 cc), peak flow (mean difference 0.43 mL/s), or residual volume (mean difference −4.51 mL), after treatment with Serenoa repens compared with placebo.
Serenoa repens (Saw Palmetto)	Barry et al., 2011 [30]	369	United States	Placebo	72 weeks	No significant difference in American Urological Association Symptom Index (AUASI) scores after treatment with Serenoa repens compared with placebo (mean difference −0.79 points).
Serenoa repens (Saw Palmetto)	Hizli & Uygur 2007 [69]	60	Turkey	Tamsulosin	6 months	No significant improvement in peak flow (mean difference −0.4 mL/s), International Prostate Symptom Scores (IPSS) (mean difference 1.5 points), prostate volume (mean difference −0.3 cc), or residual volume (mean difference 4.6 mL), after treatment with Serenoa repens compared with tamsulosin (mean difference −0.4 mL/s).
Pygeum africanum (Prunus Africana)	Barlet et al., 1990 [70]	263	Germany, France, and Austria	Placebo	60 days	Improvement in peak flow rate after treatment with pygeum africanum compared with placebo (mean difference 1.1 mL/s). No significant improvement in residual volume rate after treatment with pygeum africanum compared with placebo (mean difference -12.6 mL).
Pygeum africanum (Prunus Africana)	Chatelain et al., 1999 [36]	209	France	None	12 months	Single or bi-daily dosing had similar efficacy. IPSS scores improved from baseline by between 35 and 38%. Qmax increased by between 1.63 and 2.02 mL/s.
Cucurbita pepo	Theil et al., 2022 [39]	130	Germany	None	24 months	IPSS was improved at 12 months, on average, by 4.7 points. IIEF-5 scores indicated a minimal impact on sexual function.
Cucurbita pepo	Zerafatjou et al., 2021 [38]	73	Iran	Tamsulosin	3 months	No significant difference in International Prostate Symptom Scores (IPSS) after treatment with cucurbita pepo compared with tamsulosin (mean difference 1.81 points). No significant difference in prostate volume after treatment with cucurbita pepo compared with tamsulosin (mean difference 0.72 cc). No significant difference in peak flow after treatment with cucurbita pepo compared with tamsulosin (mean difference 1.71 mL/s).
Urtica dioica	Safarinejad 2005 [42]	558	Iran	Placebo	6 months	Significant improvement in peak flow (mean difference 4.8 mL/s), IPSS (mean difference 6.5 points), and residual volume (mean difference 37 mLs), after treatment with urtica dioica, compared with placebo.
Urtica dioica	Hosseinabadi et al., 2014 [71]	248	Iran	Prazosin	2 months	3 g/5 g/7 g, in combination, significantly improved IPSS scores after treatment, compared to treatment with prazosin alone (mean change in IPSS 10.46 points in the 7 g urtica dioica group compared with 2 points in the control group)
Epilobium angustifolium	Esposito et al., 2021 [44]	128	Italy	Placebo	6 months	Epilobium angustifolium was significantly more effective than placebo for IPSS scores (mean difference 2.5 points) and residual volume (mean difference 4.3 mL), but not for prostate volume (mean difference −1.3 cc).
Hypoxis hemerocallidea	Berges et al., 1995 [72]	200	Germany	Placebo	6 months	Peak flow (mean difference 4.1 mL/s), IPSS placebo (mean difference 5.3 points), and residual volume (mean difference 23.8 mL) were improved more in β-sitosterol (the active ingredient in hypoxis hemerocallidea) than placebo (mean difference 4.1 mL/s). There was no difference between prostate volume after treatment with β-sitosterol compared with placebo.
Hypoxis hemerocallidea	Klippel et al., 1997 [20]	177	Germany	Placebo	6 months	Hypoxis hermerocallidea was significantly more effective than placebo for IPSS scores (mean difference 5.4 points), residual volume (mean difference 33.5 mL), and peak flow (mean difference 4.5 mL/s).
Pinus pinaster	Pavone et al., 2010 [47]	80	Italy	None	12 months	Combination therapy (serenoa repens 320 mg, urtica dioica 120 mg, and pinus pinaster 5 mg)—85% of patients reported symptomatic improvement in LUTS. No improvement in prostate size or peak volume.
Solanum lycopersicum (Lycopersicum esculentum)	Lambertini et al., 2021 [49]	250	Italy	Alfuzosin	12 months	Combination therapy (alfuzosin, serenoa repens, solanum lycopersicum, lycopene, and bromelain) compared with alfuzosin alone. Combination therapy significantly decreased IPSS compared to the control group (mean difference of 5 points) and residual volume compared with the control (mean difference of 23 mL).
Roystonea regia	Guzmán et al., 2019 [51]	100	Cuba	Terazosin	6 months	D-004 (containing roystonea regia) was more effective than terazosin in reducing the IPSS score (mean difference of 1.1 points). There was no significant difference between the two groups with regard to effects on prostate volume and residual volume.
Secale cereale	Xu et al., 2008 [55]	240	China	Lower dose of secale cereale (375mg)	4 years	Cernilton (containing secale cereale), administered at 750 mg daily, was more efficacious than 375 mg daily at reducing IPSS (mean difference 5.3 points), residual volume (mean difference 11.1 mL), and peak flow (mean difference 9.5 mL/s)
Linum usitatissimum	Zhang et al., 2008 [57]	78	China	Placebo	4 months	Linum usitatissimum did not show significantly improved IPSS or peak flow over placebo. Despite this, treatment for 4 months with 600 mg of linum usitatissimum reduced IPSS by 6.88 points and improved peak flow by 2.7 mL/s.