A Cochrane review included 18 studies with a total of 1562 subjects. Compared to men receiving placebo, Pygeum africanum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures as assessed by an effect size defined by the difference of the mean change for each outcome devided by the pooled standard deviation of each outcome (-0.8 SD, 95% CI -1.4 to -0.3). Nocturia was reduced by 19%, residual urine volume by 24%, and peak urine flow was increased by 23%.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), by indirectness (differences in studied interventions and outcomes), and by imprecise results (limited study size for each comparison).