EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction

Matthias Oelke, Alexander Bachmann, Aurélien Descazeaud, Mark Emberton, Stavros Gravas*, Martin C. Michel, James N'Dow, Jørgen Nordling, Jean J. De La Rosette

*Corresponding author for this work

Research output: Contribution to journalReview article

640 Citations (Scopus)

Abstract

Objective: To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). Evidence acquisition: We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. Evidence synthesis: Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40 ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80 ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80 ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30 ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. Conclusions: These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/ pdf/12-Male-LUTS.pdf).

Original languageEnglish
Pages (from-to)118-140
Number of pages23
JournalEuropean Urology
Volume64
Issue number1
Early online date13 Mar 2013
DOIs
Publication statusPublished - 1 Jul 2013

Fingerprint

Lower Urinary Tract Symptoms
Guidelines
Prostate
Transurethral Resection of Prostate
Therapeutics
Muscarinic Antagonists
Watchful Waiting
Nocturia
Phosphodiesterase 5 Inhibitors
Polyuria
Deamino Arginine Vasopressin
Retreatment
Urinary Retention
Botulinum Toxins
Solid-State Lasers
Erectile Dysfunction
Microwaves
Catheterization
Pharmaceutical Preparations
Needles

Keywords

  • α-Adrenoreceptor antagonist
  • 5α-Reductase inhibitor
  • Benign prostatic hyperplasia
  • Bipolar transurethral resection of the prostate
  • Botulinum toxin injections
  • Desmopressin
  • Ethanol injections
  • Laser prostatectomy
  • Lower urinary tract symptoms
  • Muscarinic receptor antagonist
  • Open prostatectomy
  • Phosphodiesterase inhibitors
  • Prostate stent
  • Transurethral incision of the prostate
  • Transurethral microwave therapy
  • Transurethral needle ablation
  • Transurethral resection of the prostate

ASJC Scopus subject areas

  • Urology

Cite this

Oelke, M., Bachmann, A., Descazeaud, A., Emberton, M., Gravas, S., Michel, M. C., ... De La Rosette, J. J. (2013). EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. European Urology, 64(1), 118-140. https://doi.org/10.1016/j.eururo.2013.03.004

EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. / Oelke, Matthias; Bachmann, Alexander; Descazeaud, Aurélien; Emberton, Mark; Gravas, Stavros; Michel, Martin C.; N'Dow, James; Nordling, Jørgen; De La Rosette, Jean J.

In: European Urology, Vol. 64, No. 1, 01.07.2013, p. 118-140.

Research output: Contribution to journalReview article

Oelke, M, Bachmann, A, Descazeaud, A, Emberton, M, Gravas, S, Michel, MC, N'Dow, J, Nordling, J & De La Rosette, JJ 2013, 'EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction', European Urology, vol. 64, no. 1, pp. 118-140. https://doi.org/10.1016/j.eururo.2013.03.004
Oelke, Matthias ; Bachmann, Alexander ; Descazeaud, Aurélien ; Emberton, Mark ; Gravas, Stavros ; Michel, Martin C. ; N'Dow, James ; Nordling, Jørgen ; De La Rosette, Jean J. / EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. In: European Urology. 2013 ; Vol. 64, No. 1. pp. 118-140.
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T1 - EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction

AU - Oelke, Matthias

AU - Bachmann, Alexander

AU - Descazeaud, Aurélien

AU - Emberton, Mark

AU - Gravas, Stavros

AU - Michel, Martin C.

AU - N'Dow, James

AU - Nordling, Jørgen

AU - De La Rosette, Jean J.

PY - 2013/7/1

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N2 - Objective: To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). Evidence acquisition: We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. Evidence synthesis: Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40 ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80 ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80 ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30 ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. Conclusions: These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/ pdf/12-Male-LUTS.pdf).

AB - Objective: To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). Evidence acquisition: We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. Evidence synthesis: Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40 ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80 ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80 ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30 ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. Conclusions: These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/ pdf/12-Male-LUTS.pdf).

KW - α-Adrenoreceptor antagonist

KW - 5α-Reductase inhibitor

KW - Benign prostatic hyperplasia

KW - Bipolar transurethral resection of the prostate

KW - Botulinum toxin injections

KW - Desmopressin

KW - Ethanol injections

KW - Laser prostatectomy

KW - Lower urinary tract symptoms

KW - Muscarinic receptor antagonist

KW - Open prostatectomy

KW - Phosphodiesterase inhibitors

KW - Prostate stent

KW - Transurethral incision of the prostate

KW - Transurethral microwave therapy

KW - Transurethral needle ablation

KW - Transurethral resection of the prostate

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