Scolaris Content Display Scolaris Content Display

Beta‐sitosteroli za liječenje benigne hiperplazije prostate

Collapse all Expand all

Abstract

Background

Benign prostatic hyperplasia (BPH), nonmalignant enlargement of the prostate, can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH has been growing steadily. Phytotherapeutic preparations containing beta‐sitosterols, derived from the South African star grass, Hypoxis rooperi, or from species of Pinus and Picea, are available for the treatment of BPH.

Objectives

This systematic review aimed to assess the effects of beta‐sitosterols (B‐sitosterol) on urinary symptoms and flow measures in men with of benign prostatic hyperplasia (BPH).

Search methods

Trials were searched in computerized general and specialized databases (MEDLINE, EMBASE, Cochrane Library, Phytodok), by checking bibliographies, and by contacting manufacturers and researchers.

Selection criteria

Trials were eligible for inclusion provided they (1) randomized men with BPH to receive B‐sitosterol preparations in comparison to placebo or other BPH medications, and (2) included clinical outcomes such as urologic symptom scales, symptoms, or urodynamic measurements.

Data collection and analysis

Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. Main outcome measure for comparing the effectiveness of B‐sitosterols with placebo and standard BPH medications was the change in urologic symptom scale scores. Secondary outcomes included changes in nocturia as well as urodynamic measures (peak and mean urine flow, residual volume, prostate size). Main outcome measure for side effects was the number of men reporting side effects.

Main results

Five hundred nineteen men from four randomized, placebo‐controlled, double‐blind trials, (lasting 4 to 26 weeks) were assessed. Three trials used non‐glucosidic B‐sitosterols and one utilized a preparation that contained 100% B‐sitosteryl‐B‐D‐glucoside. B‐Sitosterols improved urinary symptom scores and flow measures. The weighted mean difference (WMD) for the IPSS was ‐4.9 IPSS points (95% CI = ‐6.3 to ‐3.5, n = 2 studies). The WMD for peak urine flow was 3.91 mL/s (95% CI = 0.91 to 6.90, n = 4 studies) and the WMD for residual volume was ‐28.62 mL (95% CI = ‐41.42 to ‐15.83, n = 4 studies). The trial using 100% B‐sitosteryl‐B‐D‐glucoside (WA184) show improvement in urinary flow measures. B‐sitosterols did not significantly reduce prostate size compared to placebo. Withdrawal rates for men assigned to B‐sitosterol and placebo were 7.8% and 8.0%, respectively.

Authors' conclusions

The evidence suggests non‐glucosidic B‐sitosterols improve urinary symptoms and flow measures. Their long term effectiveness, safety and ability to prevent BPH complications are not known.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Laički sažetak

Biljni lijekovi koji sadrže beta‐sitosterole mogu pomoći u olakšavanju simptoma i problema s protokom mokraće uzrokovanih uvećanjem prostate

Benigna hiperplazija prostate (BHP), odnosno dobroćudno povećanje žlijezde prostate, često se javlja u starijih muškaraca. Povećana prostata može ometati mokrenje, povećavajući učestalost i nagon, ili izazivati probleme s pražnjenjem mjehura. BHP se liječi lijekovima i kirurškim zahvatom. Sve češće se koriste biljni lijekovi s ciljem olakšavanja simptoma BHP, ali obično nije poznato jesu li djelotvorni i sigurni. Jedan popularni biljni tretman za BHP sadrži aktivne sastojke zvane beta‐sitosteroli. Ovaj Cochraneov sustavni pregled literature je utvrdio da se terapije beta‐sitosterolima veoma dobro podnose i da dovode do poboljšanja mokraćnih simptoma i protoka mokraće u muškaraca s blagom do umjerenom BHP. Potrebna su dodatna istraživanja u pogledu dugoročnih učinaka beta‐sitosterola.