American Urological Association (AUA), released a new clinical guideline on the surgical management of lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). The guideline has been developed by a panel with specific expertise in the guideline subject.LUTS is a term used to describe a range of symptoms related to problems of the lower urinary tract (bladder, prostate and urethra. They include
- Storage’ symptoms-like sudden or urgent need to urinate and increased the frequency of urination at night (nocturia).
- ‘Voiding’ symptoms -like weak urine stream or the inability to empty the bladder completely.
Lower urinary tract symptoms (LUTS) are more common in older men and are more often attributed to an enlarged prostate gland, otherwise known as BPH.
Major Recommendations are-
- 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.
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Dr. Kamal Kant Kohli
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