For the 2021 Management of Non-Neurogenic Male LUTS Guidelines, a detailed review and restructuring of section 5.3 Surgical Treatment has been undertaken. Section 5.3 has been restructured to reflect surgical approach rather than specific technologies and is now divided into five sections: resection; enucleation; vaporisation; alternative ablative techniques; and non-ablative techniques. In addition, a broad and comprehensive literature search related to Serenoa repens in section 5.2.5 Plant extracts – phytotherapy was performed. The search identified 118 unique references of which 21 full texts were reviewed resulting in the section being updated and inclusion of a recommendation for hexane extracted Serenoa repens.
| Summary of evidence | LE |
| HESr improves Qmax and results in fewer voids/night [0.64 (95% CI 0.98 to 0.31)] compared to placebo. | 2 |
| HESr has a very limited negative impact on sexual function. | 2 |
| Recommendations | Strength rating |
| Offer hexane extracted Serenoa repens to men with LUTS who want to avoid any potential adverse events especially related to sexual function. | Weak |
| Inform the patient that the magnitude of efficacy may be modest. | Strong |