AUA Announces Updates to Clinical Guidance for Surgical Management of LUTS Attributed to BPH

“BPH is extremely common. It affects about half of all men between ages 51 and 60 years, and up to 90 percent of men over age 80 years,” said J. Kellogg Parsons, MD, MHS, chair of the BPH Guideline Panel. “We believe this revised guideline will provide a useful, evidence-based clinical reference for the surgical management of male LUTS secondary to BPH.”

• Guideline Statement 1 was amended to include language on conducting a physical examination for the initial evaluation of patients presenting with bothersome LUTS possibly due to BPH. Additionally, supporting text was added for interpreting the results of urinalysis. It reads as follows:

• • In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should take a medical history, conduct a physical examination, utilize the AUA Symptom Index (AUA-SI), and perform a urinalysis. (Clinical Principle)

• Guideline Statements 15, 17, 18 and 22 were amended as the retreatment and possibility of treatment failure aspects of these statements are now covered under a new statement 6 under evaluation and preoperative testing. It reads:

• • Clinicians should inform patients of the possibility of treatment failure and the need for additional or secondary treatments when considering surgical and minimally-invasive treatments for LUTS secondary to BPH. (Clinical Principle)

• Statement 16 under Prostate Urethral Lift (PUL) was amended. This statement supports erectile and ejaculatory function and reads as follows:

• • PUL may be offered to eligible patients who desire preservation of erectile and ejaculatory function. (Conditional Recommendation; Evidence Level: Grade C)

• An update to Guideline statement 19 on Water Vapor Thermal Therapy was made to reflect newly published research. The new statement reads:

• • Water vapor thermal therapy may be offered to eligible patients who desire preservation of erectile and ejaculatory function. (Conditional Recommendation; Evidence Level: Grade C)

• An update to Guideline statement 21 pertaining to Laser Enucleation was made to reflect newly published research. The new statement reads:

• • Clinicians should consider holmium laser enucleation of the prostate (HoLEP) or thulium laser enucleation of the prostate (ThuLEP), depending on their expertise with either technique, as prostate size-independent options for the treatment of LUTS attributed to BPH. (Moderate Recommendation; Evidence Level: Grade B)

• Guideline statement 23 on Prostate Artery Embolization (PAE) was amended to include the following phrase: “PAE for the treatment of LUTS secondary to BPH is not supported by current data and trial designs, and benefit over risk remains unclear.” Additional changes were made to the supporting text to reflect updated information. The statement now reads:

• • PAE for the treatment of LUTS secondary to BPH is not supported by current data and trial designs, and benefit over risk remains unclear; therefore, PAE is not recommended outside the context of clinical trials. (Expert Opinion)