Contemporary use of phytotherapy in patients with lower urinary tract symptoms due to benign prostatic hyperplasia: results from the EVOLUTION European registry

Research output: Contribution to journalArticle


Background: To use the European Association of Urology Research Foundation (EAURF) registry data to determine the proportion of contemporary Lower Urinary Tract Symptoms associated with Benign Prostatic Enlargement (LUTS/BPE) patients prescribed phytotherapy, and to determine their subjective quality of life and clinical progression responses. Methods: This was a prospective multicenter multinational observational registry study, conducted over 2 years. Men ≥ 50 years seeking LUTS/BPE were divided at baseline into two cohorts, presently/recently untreated patients (PUP) commencing pharmacotherapy at baseline and presently/recently treated patients (c-PTP) continuing previously received pharmacotherapy, with 24-month follow-up (FU). Results: Overall, 2175 patients were enrolled with 1838 analyzed. Of the PUP cohort (n = 575), 92 (16%) received phytotherapy and 65 (71%, n = 65/92) completed 24-month FU, with France prescribing 34% (n = 30/89) the highest proportion of phytotherapy among all LUTS/BPE medications. In the c-PTP group (n = 1263), only 69 (5%) patients were using phytotherapy, falling to n = 35/69 (51%) at 24-month FU (highest in France 20% (n = 43/210)). Though defined disease progression occurred in ≤ 20%, with only 1% proceeding to surgical intervention, in both groups, clinically meaningful improvement was lower and symptom persistence was higher in PUP but similar in the treated (c-PTP) patients on phytotherapy compared to the other LUTS/BPE medication. Conclusion: Low heterogeneous prescribing rates for phytotherapy were reported in both PUP and c-PTP cohorts over the 24-month FU. Although phytotherapy led to subjective improvements, healthcare practitioners should prescribe them with caution until higher quality evidence and guideline recommendations supporting its use are available.


  • Nikita R. Bhatt
  • Niall F. Davis
  • W. P. Witjes
  • A. Bjartell
  • C. Caris
  • A. Patel
  • A. de la Taille
  • Mark Speakman
  • Luis Martínez-Piñeiro
  • A. Tubaro
External organisations
  • Queen Elizabeth Hospital King’s Lynn
  • Royal College of Surgeons in Ireland
  • Skåne University Hospital
  • European Association of Urology, Research Foundation
  • Assistance Publique des Hôpitaux de Paris
  • NHS Foundation Hospital
  • University Hospital La Paz
  • Sapienza University of Rome
  • Beaumont Hospital, Dublin
  • Ospedale Sant' Andrea
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Urology and Nephrology


  • Benign prostatic enlargement, Guidelines, Medical treatment, Plant extracts, Serona repens
Original languageEnglish
JournalWorld Journal of Urology
Publication statusE-pub ahead of print - 2020 Oct 16
Publication categoryResearch