AUA Releases New Clinical Guideline for Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia
BALTIMORE, May 17, 2018 /PRNewswire-USNewswire/ — Today, the American Urological Association (AUA), a leading global urology association, released a new clinical guideline on the surgical management of lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH).
LUTS is a term used to describe a range of symptoms related to problems of the lower urinary tract (bladder, prostate and urethra). They can include such ‘storage’ symptoms as a sudden or urgent need to urinate and increased frequency of urination at night (nocturia) to such ‘voiding’ symptoms as a weak urine stream or the inability to empty the bladder completely. While LUTS can affect men of any age, they are more common in older men, and more often attributed to an enlarged prostate gland, otherwise known as BPH.
Once diagnosed, treatment will depend on the cause and severity of LUTS, which is why the AUA guideline panel strongly suggests physicians and patients engage in a shared decision making process to select the best care option for each individual patient.
“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. “Selecting optimal care for each patient can be an involved process that requires physicians to help patients make informed decisions regarding their treatment plans. 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 focus of this guideline is on the treatment of LUTS attributed to BPH, utilizing common surgical techniques and minimally invasive surgical therapies. The new guideline makes 22 recommendations in total, including:
- Transurethral resection of the prostate (TURP) should be offered as a treatment option for men with LUTS attributed to BPH.
- Clinicians may use a monopolar or bipolar approach to TURP, depending on their expertise with these techniques.
- Clinicians should consider open, laparoscopic or robotic assisted prostatectomy, depending on their expertise with these techniques, for patients with large prostates.
- Clinicians should consider photoselective vaporization of the prostate (PVP) as an option using 120W or 180W platforms for patients for the treatment of LUTS attributed to BPH
- Clinicians should consider PUL as an option for patients with LUTS attributed to BPH provided prostate volume <80g and verified absence of an obstructive middle lobe; however, patients should be informed that symptom reduction and flow rate improvement is less significant compared to TURP.
- Water vapor thermal therapy may be offered to patients with LUTS attributed to BPH provided prostate volume <80g; however, patients should be informed that evidence of efficacy, including longer-term retreatment rates, remains limited.
- 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 suitable options for the treatment of LUTS attributed to BPH.
- HoLEP, PVP, and ThuLEP should be considered in patients who are at higher risk of bleeding, such as those on anti-coagulation drugs.
The guideline was developed by a panel with specific expertise in the guideline subject. It was distributed to peer reviewers of varying backgrounds as part of the AUA’s extensive peer review process before being approved by the AUA Board of Directors. The full guideline is available online at www.auanet.org/BPH.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 21,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.
Contact: Christine Frey, AUA
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SOURCE American Urological Association