Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II—Surgical Evaluation and Treatment

Abstract

Purpose: Surgical therapies for symptomatic bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) are many, and vary from minimally invasive office based to high-cost operative approaches. This Guideline presents effective evidence-based surgical management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). See accompanying algorithm for a detailed summary of procedures (figure). Materials/Methods: The Minnesota Evidence Review Team searched Ovid MEDLINE, Embase, Cochrane Library, and AHRQ databases to identify eligible studies published between January 2007 and September 2020, which includes the initial publication (2018) and amendments (2019, 2020). The Team also reviewed articles identified by Guideline Panel Members. 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, information is provided as Clinical Principles and Expert Opinions (table ). Results: Twenty-four guideline statements pertinent to pre-operative and surgical management were developed. Appropriate levels of evidence and supporting text were created to direct urologic providers towards suitable and safe operative interventions for individual patient characteristics. A re-treatment section was created to direct attention to longevity and outcomes with individual approaches to help guide patient counselling and therapeutic decisions. Conclusion: Pre-operative and surgical management of BPH requires attention to individual patient characteristics and procedural risk. Clinicians should adhere to recommendations and familiarize themselves with criteria that yields the highest likelihood of surgical success when choosing a particular approach for a particular patient.

Long-Term Risk of Surgery Following First Diagnosis of Benign Prostatic Hyperplasia in Middle-Aged Men

“…This research highlights the high utilization of surgery, particularly TURP, among middle-aged men who fail medical management for BPH and the need for treatments with a more favorable risk profile and reduced anesthetic risk. The American Urological Association has also echoed this sentiment [ 9 ].…”

Efficacy and Safety of the Sandwich Method in Patients with Benign Prostate Hyperplasia: Bipolar Transurethral Resection with GreenLight Vaporization

“…A large prostate volume in patients who underwent TURP has been shown to be associated with an increased risk of complications [ 12 ]. Currently, for the management of the patients with large prostates, two methods have been shown to be effective according to both the EAU and AUA guidelines: HoLEP and OSP [ 6 , 8 ]. However, both have limitations.…”

“…According to the American Urologic Association (AUA) guidelines in 2021, surgical management is recommended in patients with refractory urinary retention, renal insufficiency, recurrent gross hematuria or bladder stones due to BPH, recurrent urinary tract infections or LUTS refractory to other therapies, including medical therapy [ 6 ]. Various surgical treatments have been developed for BPH management, including transurethral surgery, minimally invasive surgeries, open simple prostatectomy (OSP) and robotic assisted surgeries [ 6 , 7 ]. Bipolar transurethral resection of the prostate (B-TURP) and photoselective vaporization of the prostate (PVP) are two of the possible effective surgical treatments.…”

Effects of Cytochrome P450 and Transporter Polymorphisms on the Bioavailability and Safety of Dutasteride and Tamsulosin

“…Dutasteride and tamsulosin are one of the first-line combination therapies for the management of benign prostatic hyperplasia (BPH). Combination therapy is frequent in BPH patients, due to difficulties in reaching effectiveness with single treatments (Lerner et al, 2021a;Lerner et al, 2021b).…”