LUTS

✅ Lower Urinary Tract Symptoms (LUTS)

  • What it is: A cluster of symptoms affecting urination, not exclusive to the prostate.
  • Categories:
    • Storage symptoms: urgency, frequency, nocturia
    • Voiding symptoms: weak stream, hesitancy, straining
    • Post-micturition symptoms: dribbling, incomplete emptying
  • Causes: Can be due to BPH, overactive bladder, urethral stricture, or chronic prostatitis.
  • Note: LUTS is a symptom set, not a diagnosis — it overlaps with other prostate and bladder conditions.

Clinical Overview: Lower Urinary Tract Symptoms (LUTS)

Integrating Phytotherapeutic and Herbal Interventions

Definition and Classification

Lower Urinary Tract Symptoms (LUTS) encompass a spectrum of urinary symptoms affecting the bladder, urethra, and, in men, the prostate. These symptoms are categorized into:

  • Storage Symptoms: Urgency, frequency, nocturia, and urinary incontinence.
  • Voiding Symptoms: Hesitancy, weak stream, straining, and intermittent flow.
  • Post-Micturition Symptoms: Feeling of incomplete bladder emptying and post-void dribbling.

In men, LUTS is frequently associated with Benign Prostatic Hyperplasia (BPH), while in women, causes may include overactive bladder or pelvic floor dysfunction.

Epidemiology and Risk Factors

  • Prevalence: LUTS affects approximately 30% of men over 65 and a significant proportion of postmenopausal women.
  • Risk Factors:
    • Age: Increased prevalence with advancing age.
    • Sex: Different etiologies in men and women.
    • Lifestyle: Obesity, sedentary behaviour, and high caffeine or alcohol intake.
    • Comorbidities: Diabetes mellitus, neurological disorders, and cardiovascular diseases.

Conventional Management

  • Behavioural Therapies: Bladder training, pelvic floor muscle exercises, and fluid management.
  • Pharmacological Treatments:
    • Alpha-blockers: Relax smooth muscle in the bladder neck and prostate.
    • 5-alpha-reductase inhibitors: Reduce prostate volume in BPH.
    • Antimuscarinics and β3-agonists: Address overactive bladder symptoms.
  • Surgical Interventions: Reserved for refractory cases or complications.

Phytotherapy and Herbal Interventions

Phytotherapeutic agents have been explored for managing LUTS, particularly in BPH-related cases. Their appeal lies in favourable side effect profiles and patient preference for natural remedies.

Serenoa repens (Saw Palmetto)

  • Mechanism: Inhibits 5-alpha-reductase, anti-inflammatory properties.
  • Evidence: Clinical trials have shown mixed results; some demonstrate modest improvements in urinary symptoms and flow rates.

Urtica dioica (Stinging Nettle)

  • Mechanism: Anti-inflammatory and antiproliferative effects on prostate cells.
  • Evidence: Studies indicate symptom relief when used alone or in combination with other herbs.

Pygeum africanum (African Plum Tree Bark)

  • Mechanism: Anti-inflammatory, antiandrogenic, and growth factor inhibition.
  • Evidence: Meta-analyses suggest improvements in nocturia, residual urine volume, and urinary flow rates.

Salvia miltiorrhiza (Danshen)

  • Mechanism: Reduces oxidative stress and inflammation; modulates androgen receptor signalling.
  • Evidence: Randomized controlled trials indicate significant improvements in IPSS scores without notable side effects.

Combination Therapies

  • Sabal-Urtica Extracts: Combining Serenoa repens and Urtica dioica has shown enhanced efficacy in symptom management.

Safety and Considerations

  • Adverse Effects: Generally well-tolerated; mild gastrointestinal disturbances reported.
  • Drug Interactions: Potential interactions with anticoagulants and hormonal therapies; caution advised.
  • Standardization: Variability in herbal extract preparations necessitates careful selection of standardized products.

Integrative Approach

Combining conventional therapies with phytotherapeutic agents may offer synergistic benefits. However, clinical decisions should be individualized, considering patient preferences, symptom severity, and potential interactions.

References

1.     Suter, A., et al. (2025). Phytotherapy for the Treatment of Lower Urinary Tract Symptoms: Current Evidence and Recommendations. European Urology Focus.

2.     Lopatkin, N., et al. (2020). Phytotherapy in Urolithiasis: An Updated Overview of Current Clinical Evidence. Journal of Clinical Medicine.

3.     Sperling, H., et al. (2024). Natural Products in the Treatment of Lower Urinary Tract Dysfunction and Infection. Handbook of Experimental Pharmacology.

4.     Sökeland, J., & Albrecht, J. (1997). Combination of Sabal and Urtica Extracts vs. Finasteride in BPH: A One-Year Double-Blind Study. Urologe A.

5.     Lederer, A.-K., & Michel, M. C. (2024). Natural Products in the Treatment of Lower Urinary Tract Dysfunction and Infection. Handbook of Experimental Pharmacology.

This information is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Consult a healthcare provider before starting any new supplement, especially if you have existing health conditions or are taking medication.