Benign Prostatic Hyperplasia

In practice, nettle root preparations are often prescribed in combination with other herbal medicines, such as saw palmetto or pygeum. Representative of clinical practice, most studies have investigated the effects of nettle in combination with other herbs and have generally yielded positive results.

Open studies involving a total of over 1 5 000 men with BPH have found significant improvements in prostate size, night-time urination, frequency of urination, urine flow and residual urine (ESCOP 1996-97). One double-blind study over 9 weeks of nettle extract in 50 men with BPH showed a significant decrease in sex hormone binding globulin and non-significant improvements in micturition volume and maximum urinary flow (Vontobel et al 1985); however, the authors explain that the results were due to inappropriate length and dosage of therapy. In another doubleblind, placebo-controlled study, treatment of 67 men with nettle produced a 14% improvement in urine flow and a 53% decrease in residual urine (Dathe & Schmid 1987). An open study of 30 patients with BPH showed that nettle root extract over an average of 3.5 months significantly decreased residual urine volume and increased maximal urinary flow in 50% of cases (Romics 1987). Marked subjective relief was also reported.

Urtica and Pygeum In one study, 134 patients with BPH were randomly assigned an Urtica and Pygeum preparation (300 mg U. dioica root extract combined with 25 mg P. africanum bark extract) or a preparation containing half that dose under double-blind test conditions for 8 weeks. Both treatments significantly increased urine flow, and reduced residual urine and nocturia after 28 days, whereas after 56 days, further significant decreases were found in residual urine (half-dose group) and in nocturia (both groups) (Krzeski et al 1993).

Nettle and saw palmetto extract In 1995, an open, prospective, multicentre observational study involving 419 specialist urological practices investigated the efficacy and tolerability of a saw palmetto and nettle combination in 2080 patients with BPH (Schneider et al 1995). Herbal treatment was seen to improve pathological findings and obstructive and irritative symptoms. Both efficacy and tolerability were assessed by physicians as very good or good and most patients reported an improvement in general QOL and reduction in symptoms of BPH.

A randomised, multicenter, double-blind study involving 543 patients with early stage BPH found that a combination of nettle and saw palmetto extract was as effective as finasteride at increasing maximum urinary flow and improving International Prostate Symptom Scores (IPSS) after 24 weeks' treatment, which continued to improve by week 48 (Sokeland 2000). Improvement in QOL scores were similarly observed with both treatments, regardless of prostate size. Overall, the two treatments only differed in regard to adverse reaction incidence, with the herbal combination much better tolerated (Sokeland &Albrecht 1997). A 2003 review concluded that a combination of nettle and saw palmetto is safe and effective for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia, comparable to the alpha-blocker tamsulosin (Bondarenko et al 2003).

A randomised, placebo controlled, double-blind, multicentre trial in 2005 further demonstrated the effectiveness of saw palmetto fruit (160 mg) and nettle root (120 mg) for lower urinary tract symptoms due to prostate enlargement (Lopatkin et al 2005): 257 men aged 50 years or more were randomised to take either two capsules of the study medication (320 mg saw palmetto and 240 mg nettle root) daily or placebo for 24 weeks. Men on the treatment experienced a 35% reduction in symptoms, most notably intermittency, hesitancy, urgency and nocturia, compared to 24% for placebo. At the end of the 24-week period an open trial was conducted for an additional 24 weeks and all men were given the herbal medicine. Those previously taking placebo reported significant improvements when switched to the study medication.

Commission E approved the use of Urtica root for difficulty in urination in BPH stages 1 and 2 (Blumenthal et al 2000).

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