madman
Super Moderator
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.
GUIDELINE STATEMENT UPDATES
The statements summarized herein constitute the 2023 amendment; however, users are encouraged to reference the unabridged guideline for a complete listing of guideline statements and more detailed discussion. A summary of procedures discussed in the guideline is also detailed in the accompanying algorithms (Figures 1-3).
Combination Therapy 19.
Anticholinergic agents, alone or in combination with an a blocker, may be offered as a treatment option to patients with moderate to severe predominant storage LUTS. (Conditional Recommendation; Evidence Level: Grade C)
*Anticholinergics as Monotherapy
*Anticholinergic Therapy in Combination with Alpha Blockers
*Combined Mirabegron and Doxazosin Versus Active Comparartor
*Combination of Low-Dose Daily Tadalafil with Alpha Blockers
*Photoselective Vaporization of the Prostate (PVP)
*Water Vapor Thermal Therapy (WVTT)
*Laser Enucleation
*Prostate Artery Embolization (PAE)
*Temporary Implanted Prostatic Devices (TIPD)
FUTURE DIRECTIONS
Recognizing the importance of equitable healthcare delivery, it is imperative to address the underrepresentation of diverse populations in research related to BPH. Therefore, the inclusion of diverse populations in BPH research studies should be encouraged, including individuals from different ethnic, racial, socioeconomic, and cultural backgrounds.
New Therapeutic Options
There have been new therapeutic options utilized for LUTS/BPH over the past few years. Despite the expansion of the treatment algorithm, the ceiling on medical therapy has not been well elucidated. The potential role of combination therapy and other routes of delivery are under investigation and remain to be defined. These include changes in dosing patterns (eg, weekly, monthly). Moreover, many promising MISTs and surgical alternatives are in development, including prostatic stents, temporary implantable prostatic devices (TIPD), drug eluting catheters, balloon dilation devices, and transurethral prostatic split techniques to name a few. It is the hope of this Panel that further robust data will be available in the peer reviewed literature on these therapies to allow incorporation into future iterations of this guideline. To guarantee that newer technologies genuinely deliver enhanced improvements and outcomes for patients, it is crucial to maintain an ongoing benchmarking process that consistently compares new technologies to established technologies. With so many MISTs being developed for LUTS/BPH, the Panel is compelled to consider the necessary attributes to qualify as reasonable MIST therapies, as well as which patient characteristics will likely confer successful outcomes with each individual MIST option.
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.
GUIDELINE STATEMENT UPDATES
The statements summarized herein constitute the 2023 amendment; however, users are encouraged to reference the unabridged guideline for a complete listing of guideline statements and more detailed discussion. A summary of procedures discussed in the guideline is also detailed in the accompanying algorithms (Figures 1-3).
Combination Therapy 19.
Anticholinergic agents, alone or in combination with an a blocker, may be offered as a treatment option to patients with moderate to severe predominant storage LUTS. (Conditional Recommendation; Evidence Level: Grade C)
*Anticholinergics as Monotherapy
*Anticholinergic Therapy in Combination with Alpha Blockers
*Combined Mirabegron and Doxazosin Versus Active Comparartor
*Combination of Low-Dose Daily Tadalafil with Alpha Blockers
*Photoselective Vaporization of the Prostate (PVP)
*Water Vapor Thermal Therapy (WVTT)
*Laser Enucleation
*Prostate Artery Embolization (PAE)
*Temporary Implanted Prostatic Devices (TIPD)
FUTURE DIRECTIONS
Recognizing the importance of equitable healthcare delivery, it is imperative to address the underrepresentation of diverse populations in research related to BPH. Therefore, the inclusion of diverse populations in BPH research studies should be encouraged, including individuals from different ethnic, racial, socioeconomic, and cultural backgrounds.
New Therapeutic Options
There have been new therapeutic options utilized for LUTS/BPH over the past few years. Despite the expansion of the treatment algorithm, the ceiling on medical therapy has not been well elucidated. The potential role of combination therapy and other routes of delivery are under investigation and remain to be defined. These include changes in dosing patterns (eg, weekly, monthly). Moreover, many promising MISTs and surgical alternatives are in development, including prostatic stents, temporary implantable prostatic devices (TIPD), drug eluting catheters, balloon dilation devices, and transurethral prostatic split techniques to name a few. It is the hope of this Panel that further robust data will be available in the peer reviewed literature on these therapies to allow incorporation into future iterations of this guideline. To guarantee that newer technologies genuinely deliver enhanced improvements and outcomes for patients, it is crucial to maintain an ongoing benchmarking process that consistently compares new technologies to established technologies. With so many MISTs being developed for LUTS/BPH, the Panel is compelled to consider the necessary attributes to qualify as reasonable MIST therapies, as well as which patient characteristics will likely confer successful outcomes with each individual MIST option.
