AUA: Guideline on Surgical Management of BPH-Related Lower Urinary Tract Symptoms

The American Urological Association (AUA) has issued a new clinical practice guideline on the surgical management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). 

In the guideline, the AUA expert panel encourages a shared decision-making process as the basis for choosing the most appropriate care for patients. “There are many effective surgical options for treating LUTS due to BPH,” said Harry E. Foster, Jr., MD, Chair of the guideline development panel and Professor in the Department of Urology at Yale University School of Medicine. “This new clinical guideline offers both a framework to facilitate such shared decision-making, and guidance as to which surgical treatments are appropriate for treating BPH.”

The new guideline includes 22 recommendations focused on utilizing common surgical techniques and minimally invasive surgical therapies. Some of the main recommendations are:

• For men with LUTS attributed to BPH, transurethral resection of the prostate (TURP) should be offered as a treatment option (moderate recommendation)
• Depending on a clinician’s expertise, a monopolar or bipolar approach to TURP may be used (expert opinion)
• For patients with large prostates, laparoscopic or robotic assisted prostatectomy should be considered (depending on clinician expertise) (moderate recommendation)
• Photoselective vaporization of the prostate (PVP) should be considered an option using 120W or 180W platforms (moderate recommendation)
• Prostatic urethral lift should be considered an option provided the prostate volume is <80g and the absence of an obstructive middle lobe has been verified (patients should be informed that symptom reduction and flow rate improvement is less significant compared to TURP) (moderate recommendation)
• Water vapor thermal therapy may be offered provided the prostate volume is <80g, however patients should be informed that evidence and safety (including longer-term retreatment rates) remains limited (conditional recommendation)
• Holmium laser enucleation of the prostate (HoLEP) or thulium laser enucleation of the prostate (ThuLEP) should be considered as prostate size-independent suitable options, depending on clinician expertise (moderate recommendation)
• HoLEP, PVP, and ThuLEP should be considered in patients who are at higher risk of bleeding, such as those on anticoagulation drugs (expert opinion)

The full guideline is available here.

For more information visit AUAnet.org.