6th International Consultation Research Articles

Management using continence products: Report of the 7th International Consultation on Incontinence

Aim:To summarise the available evidence on the use of continence products to manage urinary or faecal incontinence published since the 6th International Consultation on Incontinence (2017) and provide key recommendations for the use of products in each group. Methods:A series of systematic reviews (grouped according to pre-determined topics) and evidence updates were undertaken and reported descriptively by members of an international committee to update the 6th Consultation. Results:The available evidence is presented for 13 categories of continence management products. Some categories (female mechanical urinary incontinence devices, products for preventing/treating incontinence-associated dermatitis and urinary catheters) had at least one new randomised controlled trial. Other categories had small-scale or qualitative studies, reviews or no new associated evidence. A summary of key research priorities is provided. Discussion:This paper provides a summary of the evidence available for a range of continence management products. Some product categories have a larger body of new and existing evidence than others, but there continues to be a lack of research to guide decision-making on the wide range of continence management products. Clinicians and other decision-makers remain largely dependent on expert opinion and individual user circumstances and preferences. We summarise specific areas where more.

Physiotherapy Assessment to Identify the ‘5 Fs’: A Concept of Innovative Pelvic Floor Training

In the recommendations of the 6th International Consultation of Incontinence (ICI) [1] physiotherapy is considered a level 1, grade A, first-line treatment for the most prevalent kinds of urinary incontinence, stress-, urgency- and mixed urinary incontinence. When the attentive reader carefully looks at the ICI algorithms regarding initial management of urinary incontinence in women, he or she will find out that the medical diagnosis is actually no more than a ‘presumed diagnosis’ [2] . So, it might be that, based on such medical data, patients will be send for treatment to a physiotherapist with unclear health problems, underlying pathology and consequences [3]. Therefore, a physiotherapeutic assessment is essential to find out if, and to what extent, physiotherapy is helpful to deal with the consequences of the health problem urinary incontinence and what treatment components are warranted [3].

Re: Review of the 6th International Consultation on Incontinence: Primary Prevention of Urinary Incontinence.

Re: Review of the 6th International Consultation on Incontinence: Primary Prevention of Urinary Incontinence.

Review of the 6th International Consultation on Incontinence: Primary prevention of urinary incontinence.

To report the state of the science on primary prevention of urinary incontinence (UI) in adults from the 6th International Consultation on Incontinence with an update through January 2019. Online databases PubMed, CINAHL, PsycInfo, and Medline were searched in March 2016 and February 2019 with a focus on literature published after 2010. The International Consultation on Urological Diseases modified Oxford Centre for Evidence-Based Medicine Levels of Evidence and grades of recommendation were used to evaluate the literature. Grade B recommendations to prevent UI in pregnant and postpartum women are available and promising evidence exists for educational interventions to prevent UI up to 2 years in older women. There is little evidence for adding preoperative pelvic floor muscle exercises to postprostatectomy pelvic floor muscle exercises for men to regain continence. Insufficient evidence exists for the effectiveness of screening for UI in women. The absence of information on primary prevention remains for adolescents, nulliparous and perimenopausal women, and middle-aged and aged men and women. Few primary prevention interventions for UI exist for specific populations, especially pregnant and postpartum women. Research interest in developing foundational knowledge to design these interventions is growing.

Surgery for female SUI: The ICI algorithm.

Stress urinary incontinence (SUI) is common in women and can significantly impact quality of life. This is a review of the 6th International Consultation on Incontinence (ICI) chapter analyzing level of evidence on surgical treatment of SUI as well as the consensus algorithm that resulted from the detailed work in the committee report as of April 2017. Included studies in this review were selected to highlight the algorithm for management. Non-operative and surgical treatment options exist; conservative therapies comprise first line management, but if SUI remains bothersome, surgical treatment should be considered. Bulking agents offer a minimally invasive option with moderate short-term success rates. The most commonly performed surgical treatments for SUI are mid-urethral and pubovaginal slings, with high cure rates and patient satisfaction. Retropubic suspension is a more traditional but widely accepted procedure. Single incision sling, adjustable sling, or artificial urinary sphincter may be appropriate in carefully selected patients. The choice of surgical procedure should be made only after a thorough discussion and shared decision between the patient and surgeon regarding risks, benefits, and alternatives. A trial of conservative therapy should be conducted where relevant. Referral to a specialist should be considered in women with a more complex presentation.

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence.

Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non-surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th International Consultation on Incontinence.

To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.

6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: EVALUATION AND TREATMENT OF URINARY INCONTINENCE, PELVIC ORGAN PROLAPSE AND FAECAL INCONTINENCE.

Scientific report of the proceedings from the 6th International Consultation on Incontinence, (Tokyo 2016).

Is testosterone important in LUT function in men and women? ICI-RS 2015.

This review article is a collaborative report based upon the Authors' presentations and Group discussion on the role of testosterone (T) in the male and female lower urinary tract (LUT) which took place at the 6th International Consultation on Incontinence Research Society's (ICI-RS) annual meeting, in Bristol, UK (September 8-10, 2015). It comprises overviews and opinions on both the current state of knowledge of the role of T in LUT function and dysfunction in both sexes. Results from animal studies suggest that T treatment may be beneficial for disorders of the LUT in women including urinary incontinence and pelvic organ prolapse. The need for clinical studies to evaluate the effect of T treatment in peri- and post-menopausal women, taking into account the type of applied androgen, the application form, timing and dosage, is especially emphasized. In males, findings on the impact of T on the male external urethral sphincter underscores that there is still much to learn about its role in male LUT physiology. The important topic of the use of T therapy in the treatment of enuresis in the young, both sexes, is also discussed. The importance of understanding the steroidogenic pathways linking T with estradiol is discussed as being of paramount importance in researching the unique actions of T in the LUT. The overall conclusion is that further research into the role of T in LUT function and dysfunction across genders and age groups (young to old) is extremely important. Neurourol. Urodynam. 36:859-862, 2017. © 2017 Wiley Periodicals, Inc.

S&T-62 EFFECT OF PULSED MAGNETIC STIMULATION ON SEXUAL FUNCTION IN COUPLES WITH INCONTINENT PARTNERS

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-62 EFFECT OF PULSED MAGNETIC STIMULATION ON SEXUAL FUNCTION IN COUPLES WITH INCONTINENT PARTNERS Renly Lim, Men Long Liong, Wing Seng Leong, Nurzalina Abdul Karim Khan, and Kah Hay Yuen Renly LimRenly Lim More articles by this author , Men Long LiongMen Long Liong More articles by this author , Wing Seng LeongWing Seng Leong More articles by this author , Nurzalina Abdul Karim KhanNurzalina Abdul Karim Khan More articles by this author , and Kah Hay YuenKah Hay Yuen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2891AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 5th International Consultation on Incontinence recommends that research in female stress urinary incontinence (SUI) should assess treatment impact on sexual function. Recent published studies have highlighted the interdependence between male and female sexual function. We evaluated the effect of the under-studied non-surgical treatment pulsed magnetic stimulation (PMS) on sexual function in female subjects with SUI and their partners. METHODS Couples with female SUI partners, at least 21 years old and sexually active were recruited. SUI subjects received 16 or 32 PMS sessions (twice a week) depending on treatment response. Treatment responders were defined as a 5-point reduction in the International Consultation on Incontinence Questionnaire for Urinary Incontinence-Short Form (ICIQ-UI SF) (range 0 to 21). Prior to and at 6-months post-treatment, the female subjects completed the ICIQ-UI SF, while both partners completed two key parameters; i) Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire (range 0 to 96) and ii) single-item question on overall sexual experience, ‘Over the past 4 weeks, how satisfied have you been with your overall sexual life?’. The GRISS questionnaire is a highly recommended questionnaire by the 5th International Consultation on Incontinence with comparable male and female subscales to assess sexual function in couples, and has been translated and validated by our research team in the Malaysian population. RESULTS 53 of 66 couples (80.3%) completed reassessments at 6-months post-treatment. Mean reduction (Mdiff) ± standard error (SE) in the ICIQ-UI SF score was -6.55 ± 0.46 (p<0.001). Based on the overall GRISS score, there were significant improvements in both female subjects (Mdiff -5.16, SE 1.31, p<0.001) and their partners (Mdiff -3.38, SE 1.21, p=0.008). Based on the single-item question on overall sexual experience, there was a significant increase in the percentage of female subjects who felt ‘moderately satisfied’ or ‘very satisfied’ (p=0.032) but no significant change in their partners (p=0.330). Subgroup analysis showed that female subjects who received 32 sessions (Mdiff -8.64, SE 2.09, p=0.015) had twice the mean reduction compared with 16 sessions (Mdiff -4.03, SE 1.57, p=0.002). In contrast, a longer treatment duration did not lead to significant improvement in sexual function of their male partners (Mdiff -2.23, SE 2.64, p=0.414). CONCLUSIONS PMS improve sexual function of both the female subjects and their partners. Increasing the number of PMS sessions may further improve female sexual function. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e334 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Renly Lim More articles by this author Men Long Liong More articles by this author Wing Seng Leong More articles by this author Nurzalina Abdul Karim Khan More articles by this author Kah Hay Yuen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence.

The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Revision and updates of the 4th ICI Report using systematic review covering years 2008-2012. Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a "grade of recommendation." The paper concludes with areas identified as requiring further research. For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation. Neurourol. Urodynam. 35:15-20, 2016. © 2014 Wiley Periodicals, Inc.

Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence

Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. To update the recommendations of the 4th ICI. A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology. Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder. The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area.

Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men

The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease. A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system. The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as "clinical benign prostatic hyperplasia" or "the benign prostatic hyperplasia patient" be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms. The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used.

Fourth international consultation on incontinence recommendations of the international scientific committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence

Scientific report of the proceedings from the 6th International Consultation on Incontinence, (Tokyo 2016).

Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men

The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease. A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system. The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as "clinical benign prostatic hyperplasia" or "the benign prostatic hyperplasia patient" be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms. The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used.

Critical Review of Guidelines for BPH Diagnosis and Treatment Strategy

Objectives To provide a critical overview of the currently available guidelines on benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Methods Through a nonsystematic review of MEDLINE, we identified the guidelines produced by the following institutions: American Urological Association (AUA), Australian National Health and Medical Research Council (NHMRC), British Association of Urological Surgeons (BAUS), Canadian Urological Association, European Association of Urology (EAU), and the 5th International Consultation on BPH. All the guidelines were evaluated by the international appraisal instrument provided by the Appraisal of Guidelines, Research and Evaluation (AGREE) collaboration. Moreover, the recommendations concerning diagnosis and treatment from the different guidelines were compared. Results A wide discrepancy was observed among the overall quality of the guidelines. The guidelines from the Australian NHMRC and from the AUA yielded the highest overall scores, with 86 and 72 points, respectively. According to the domains of the AGREE appraisal instrument, the scores concerning “scope and purpose” and “clarity and presentation” were quite high and quite similar among the different documents, whereas the most relevant differences were observed in domains concerning the methodology of development of the guidelines. Conclusion Although all the texts had some good aspects, we found considerable differences in the overall quality of the available guidelines, especially with regard to the methodologic issues. The guidelines from the Australian NHMRC and AUA were most adherent to the standards of quality suggested by the AGREE appraisal instrument. In cases of controversial issues, clinicians could use the summarised data to select the guidelines they trusted the most to be used in their clinical practice.

Post-Void Residual Urine Volume is Not a Good Predictor of the Need for Invasive Therapy Among Patients With Benign Prostatic Hyperplasia

We assessed the value of baseline PVR as predictor of the need for invasive therapy during long-term followup of patients with clinical BPH treated initially with alpha1-blockers or WW. The records of a cohort of 942 patients with BPH treated with alpha(1)-blockers or WW were reviewed. Baseline I-PSS scores, PSA, prostate volume, uroflowmetry, pressure flow parameters and followup data were collected prospectively. Correlations between PVR and other baseline parameters were calculated. The 5-year cumulative risks of invasive therapy were calculated with the Kaplan-Meier method. After stratification of PVR by various cutoff levels (50, 100 and 300 ml), rate ratios between large and small PVRs were calculated using proportional hazards analyses. PVR has weak (-0.2<R <0.2) correlations with other baseline parameters. With increasing PVR cutoff levels, the 5-year cumulative risk of invasive therapy for the large PVR subgroup, increases from 45% to 64% and from 15% to 21% in the alpha1-blockers and WW group, respectively. Large PVR yields a significant 2-fold up to a 4-fold increased risk of invasive therapy compared to small PVR in both treatment groups. In multivariate models these significant risk differences largely disappear, although a statistically not significant higher risk remains for the large PVR (greater than 300 ml) patients. In general, baseline PVR has little prognostic value for the risk of BPH related invasive therapy in patients on alpha1-blocker and WW. Only patients with large PVR have a 2-fold increased risk of invasive therapy compared to patients with smaller PVR.

The Impact of Nocturia in Patients with LUTS/BPH: Need for New Recommendations

Although nocturia has been recognised as one of the most bothersome symptoms in men suffering from lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), its impact on quality of life (QoL) is often underestimated. Recent studies have shown a substantial negative effect of nocturia on quality of sleep, energy/vitality and social functioning. In addition, it has been shown that quality of sleep is significantly affected by the hours of undisturbed sleep (HUS), defined as the time between going asleep and the first awakening (to void). These considerations formed the basis to investigate current opinion on the appropriate evaluation of nocturia amongst both practising urologists and urological experts. For that purpose, firstly a discussion forum was organised at the 6th International Consultation on Prostate Cancer and Prostate Diseases (Paris, June 24, 2005), followed by a meeting of an expert consensus panel (Sheffield, September 24, 2005). Based on the results of both meetings, seven position statements were formulated regarding the measurement of nocturia and its impact on QoL in future research. Participants of both the discussion forum and the expert consensus meeting confirmed the importance of the appropriate evaluation of nocturia in patients with LUTS/BPH, focusing on an accurate analysis of its causes, and also on its impact on quality of sleep and QoL. The concept of HUS was broadly acknowledged as a potentially important parameter in assessing sleep disturbance due to nocturnal voids. The expert panel recommended that the relation between nocturia, quality of sleep and QoL should be incorporated into new studies on the efficacy of treatments for LUTS/BPH. Sleep logs/diaries, the measurement of HUS (by either sleep logs or recently developed instruments such as the actigraph) and the Nocturia Specific Quality of Life questionnaire (N-QOL) were suggested as important tools to measure nocturia and its impact in future clinical and epidemiological studies.

A COST COMPARISON OF MEDICAL MANAGEMENT AND TRANSURETHRAL NEEDLE ABLATION FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA DURING A 5-YEAR PERIOD

We performed an analysis comparing the cost of medical management with TUNA therapy for a 5-year period. Published costs for tamsulosin, finasteride, transurethral needle ablation (TUNA, Medtronic, Inc., Minneapolis, Minnesota) and transurethral resection of the prostate were used to construct a cost analysis model comparing medication with TUNA. The model analyzed monotherapy with an alpha-blocker (tamsulosin) and a 5alpha-reductase inhibitor (finasteride), combination therapy using both medications, and a mixed scenario using monotherapy and combination therapy. Published data were used to estimate the rate of surgical intervention in patients initially treated with medications or TUNA. Tamsulosin monotherapy was less expensive than TUNA for 5 years ($3,485 for tamsulosin vs $4,811 for TUNA year 5). Finasteride monotherapy reaches a break-even point with TUNA during year 5 ($4,867 for finasteride vs $4,811 for TUNA). Combination therapy reaches a break-even point with TUNA after approximately 2 years 7 months of treatment ($4,515 for combination therapy vs $4,572 for TUNA) and the mixed scenario breaks even with TUNA at approximately year 4 ($4,696 for medical management vs $4,645 for TUNA). The TUNA procedure compares favorably to combination medical therapy for the treatment of benign prostatic hyperplasia on a cost basis. alpha-Blocker monotherapy is less costly than TUNA while 5alpha-reductase inhibitor monotherapy is approximately equivalent to TUNA for 5 years. The TUNA procedure is less expensive than combination medical management for 5 years, with a break-even point at approximately 2 years 7 months.

Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract.

Recommendations regarding the use of plant-derived medications for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) state that every brand should be fully evaluated and considered separately. Disparity between a number of brands in terms of their stated and actual doses has been recently highlighted. The aim of this study was to fully quantify the variation in Serenoa repens extracts (SrE) commercially available for the treatment of BPH-associated LUTS. To this end, 14 brands of SrE were compared. Concentrations of free fatty acids (FFAs), methyl and ethyl esters, long-chain esters and glycerides were assessed using liquid and gas chromatography. Many of the brands showed a significantly different proportional content which may have an impact on their clinical efficacy and safety. The high concentrations of FFAs in particular, which previous research has suggested as comprising the active agent of SrE for the treatment of LUTS, may influence the clinical benefit derived from each product. Our findings lend further weight to recommendations by the 5th International Consultation on BPH that plant-derived treatments should be analysed and considered as independent entities despite their common origin. Only extracts with demonstrated pharmacological activities and proven clinical efficacy should be considered for the treatment of patients with BPH.