Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023

Abstract

Purpose:The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH).Materials and Methods:The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.Results:The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text.Conclusion:This guideline seeks to improve clinicians’ ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care.

New Pimarane Diterpenoids Isolated from EtOAc-Extract of Apiospora arundinis Culture Medium Show Antibenign Prostatic Hyperplasia Potential

“…Benign prostatic hyperplasia (BPH) is a common urological disease among middle-aged and elderly men. BPH is histologically diagnosed based on the proliferation of smooth muscle and epithelial cells within the prostatic transition zone . BPH contributes to escalated health care costs and diminishes quality of life .…”

Enhanced clinical decisions for management of benign prostatic hyperplasia using patient-reported outcomes: protocol for a prospective observational study

“…Lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) are common, affecting approximately 33% of Medicare beneficiaries [ 1 ]. As the most common condition contributing to non-neurogenic LUTS in men, BPH is also the focus of frequently updated medical and surgical management guidelines that directly influence provider decision-making and patient care [ 2 , 3 ]. The burden of LUTS/BPH is expected to increase, both in the US and worldwide, due to shifting demographics and a static urologic workforce [ 4 ].…”

“…Measuring outcomes provides a way to track progress, adjust treatments, monitor quality of care, and help patients achieve optimal outcomes. For decades, the American Urological Association Symptom Index (AUA-SI) has been the patient-reported outcome (PRO) measure used in men with BPH, as recommended in the “Surgical Management” guidelines updated as recently as 2023 [ 2 , 5 ]. The AUA-SI, however, has several limitations that leave room for improvement.…”

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

“…Surgical treatment benign prostatic obstruction (BPO) can be categorised into resection, enucleation, vaporisation, alternative ablative techniques and non-ablative techniques [ 1 ]. Large (> 80 cc) prostate size often presents a heightened surgical challenge and the therapeutic options at the surgeon’s disposal have historically been more limited [ 2 ]. However, enucleation methods represent an alternative that can yield improved efficacy and safety compared to the traditional standard of open simple prostatectomy (OSP).…”