Can a combination of tamsulosin and herbal medicine improve lower urinary tract symptoms due to benign prostatic hyperplasia?

This study assessed the effectiveness and safety of combined therapy of tamsulosin (Flomax) and two different traditional herbal medicines in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). The study showed that tamsulosin with Ryutanshakanto provided pain relief in patients with chronic prostatitis and chronic pelvic pain syndrome.

BPH is a condition commonly seen in older men and involves enlargement of the prostate gland. It is a major cause of LUTS in patients and affects their quality of life (QoL). LUTS include dribbling, weak stream, incomplete bladder emptying, painful urination, frequent urination, and urgency. First-line therapy for LUTS and BPH includes alpha-blockers such as tamsulosin with or without 5-alpha-reductase inhibitors. This therapeutic approach has produced variable results along with unwanted side effects.

Two traditional herbal medicines used in Asian countries are Hachimijiogan (HJG) and Ryutanshakanto (RST). These herbal medicines may provide a supplemental effect in improving LUTS and BPH for patients in which conventional medicine has produced side effects and limited effectiveness. However, the effectiveness and safety of combining these herbal medicines with tamsulosin are unknown.

This study included 39 patients with LUTS due to BPH. They were randomly assigned to one of 3 groups. Group 1 included 16 patients who received 0.2 mg of an oral solution of tamsulosin daily, with orally administered HJG at a dose of 3 mg, three times daily. Group 2 included 15 patients who were given 0.2 mg of an oral solution of tamsulosin daily, with orally administered RST at a dose of 3 mg, three times daily. Group 3 included 8 patients who received 0.2 mg of an oral solution of tamsulosin daily, with a placebo. The International Prostate Symptom Score (IPSS) for evaluating BPH severity, QoL index, complete voiding diary, and National Institutes of Health-Chronic Prostatitis Symptom Index were determined at the beginning of the study and at 4 weeks, 8 weeks, and 12 weeks.

Patients in group 2 showed a significant decrease in pain after treatment with tamsulosin and RST, compared to group 3. There were improvements in IPSS, QoL, prostate volume, urine flow, and prostatitis symptoms across all treatment groups, but these were not significant.

The study suggested that RST may be useful in providing pain relief to patients with long-term inflammation of the prostate and pelvic pain when added to an alpha-blocker such as tamsulosin.

The study had a small number of patients. A fairly large prostate that was less responsive to treatment and required surgical treatment occurred in some patients. More studies of larger sizes with longer follow-ups are needed.