Management of Non-neurogenic Male LUTS

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

2021

For the 2021 Management of Non-Neurogenic Male LUTS Guidelines, a detailed review and restructuring of section 5.3 Surgical Treatment has been undertaken. Section 5.3 has been restructured to reflect surgical approach rather than specific technologies and is now divided into five sections: resection; enucleation; vaporisation; alternative ablative techniques; and non-ablative techniques. In addition, a broad and comprehensive literature search related to Serenoa repens in section 5.2.5 Plant extracts – phytotherapy was performed. The search identified 118 unique references of which 21 full texts were reviewed resulting in the section being updated and inclusion of a recommendation for hexane extracted Serenoa repens.

Summary of evidence LE
HESr improves Qmax and results in fewer voids/night [0.64 (95% CI 0.98 to 0.31)] compared to placebo. 2
HESr has a very limited negative impact on sexual function. 2

 

Recommendations Strength rating
Offer hexane extracted Serenoa repens to men with LUTS who want to avoid any potential adverse events especially related to sexual function. Weak
Inform the patient that the magnitude of efficacy may be modest. Strong

 

2020

For the 2020 Management of Non-Neurogenic Male LUTS Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the Non-Neurogenic Male LUTS Guidelines was performed. The search was limited to studies representing high levels of evidence, i.e. systematic reviews with meta-analysis, randomised controlled trials (RCTs), and prospective non-randomised comparative studies, published in the English language. The scope search identified 1,254 unique references of which 228 full texts were reviewed resulting in 29 additional references and text updates being incorporated throughout the 2020 version of the Non-Neurogenic Male LUTS Guidelines. Specific changes include:

Chapter 5.3 Surgical treatment

  • Section 5.3.1.1.1 – Updated recommendation for bipolar transurethral vaporisation of the prostate resulting in a change in strength rating.
Recommendation Strength rating
Offer bipolar transurethral vaporisation of the prostate as an alternative to monopolar TURP to surgically treat moderate-to-severe LUTS in men with prostate size of 30-80 mL. Strong

 

  • Section 5.3.7 Techniques under investigation – recommendations for Aquablation and prostatic artery embolisation have been defined following a structured assessment of the available evidence.
Summary of evidence LE
Aquablation appears to be as effective as TURP both subjectively and objectively; however, there are still some concerns about the best methods of achieving post-treatment haemostasis 1b

 

Recommendations  Strength rating
Offer Aquablation to patients with moderate-to-severe LUTS and prostates between 30 – 80 mL as an alternative to TURP. Weak
Inform patients about the risk of bleeding and the lack of long-term follow up data. Strong

 

Summary of evidence LE
Prostatic artery embolisation is less effective than TURP at improving symptoms and urodynamic parameters such as flow rate. 1a
Procedural time is longer for PAE compared to TURP but blood loss, catheterisation and hospitalisation time are in favour of PAE. 1b

 

Recommendations Strength rating
Offer prostatic artery embolisation (PAE) to men with moderate-to-severe LUTS who wish to consider minimally invasive treatment options and accept less optimal objective outcomes compared with transurethral resection of the prostate. Weak
Perform PAE only in units where the work up and follow up is performed by urologists working collaboratively with trained interventional radiologists for the identification of PAE suitable patients. Strong

 

2019

For the 2019 Management of Non-Neurogenic Male LUTS Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the Non-Neurogenic Male LUTS Guidelines was performed. The search was limited to studies representing high levels of evidence, i.e. systematic reviews with meta-analysis, randomised controlled trials (RCTs), and prospective non-randomised comparative studies, published in the English language. As a result of the scoping search additional references and text updates have been incorporated throughout the 2019 version of the Non-Neurogenic Male LUTS Guidelines. Specific changes include:

Chapter 5.3 Surgical treatment

  • Transurethral microwave therapy (TUMT) and transurethral needle ablation of the prostate (TUNA) have been removed from the Guidelines. Information on to both of these techniques may now be found in the Non-Neurogenic Male LUTS Guidelines Supplementary Online Material.
  • Section 5.3.7 Techniques under investigation has replaced section 5.3.8 Novel Interventions from the 2018 Guidelines. Section 5.3.7 addresses: Minimal invasive simple prostatectomy; (i)TIND; Aquablation – image guided robotic waterjet ablation; Convective water vapour energy (WAVE) ablation; and Prostatic artery embolization.

Chapter 5.5 Management of Nocturia in men with lower urinary tract symptoms

  • The recommendations relating to the use of desmopressin for the treatment of nocturia have been revised following a structured assessment of the available evidence.

2018

For the 2018 edition of the EAU Male LUTS Guidelines the Guidelines Office have transitioned to a modified GRADE methodology. For each recommendation within the guidelines there is an accompanying online strength rating form which addresses a number of key elements namely:

  1. the overall quality of the evidence which exists for the recommendation;
  2. the magnitude of the effect (individual or combined effects);
  3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
  4. the balance between desirable and undesirable outcomes;
  5. the impact of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence, and nature and variability of patient values and preferences. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’. All recommendations have been rephrased throughout the current document to aid in their implementation.

In addition, the following sections of the Male LUTS have been adapted or added to the text:

  • 5.3.1.1.1 Modifications of B-TURP: bipolar transurethral vaporisation of the prostate
  • 5.3.5 Laser treatments of the prostate
  • 7 Topics under consideration for future evaluation by the Male LUTS Guidelines Panel

2017

For the 2017 Management of Non-Neurogenic Male LUTS Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the Non-Neurogenic Male LUTS Guidelines was performed. The search was limited to studies representing high levels of evidence, i.e. systematic reviews with meta-analysis, randomised controlled trials (RCTs), and prospective non-randomised comparative studies, published in the English language. Additional references and text updates have been incorporated throughout the text as a result of this search. Furthermore, all recommendations have been rephrased throughout the current document to aid in their implementation.

2016

All chapters of the 2016 Non-Neurogenic Male Lower Urinary Tract Symptoms Guidelines have been updated, based on the 2015 version of the guideline. Conclusions and recommendations have been rephrased and added to, throughout the current document.

Key changes in the 2016 print:

• Section 4.13.3 Non-invasive pressure-flow testing.
• Section 4.13.4 The diagnostic performance of non-invasive tests in diagnosing bladder outlet obstruction in men with LUTS compared with pressure-flow studies.
• Section 5.5 Management of Nocturia in men with lower urinary tract symptoms.

2015

For the 2015 Guidelines, the text has been significantly reduced so that only key information is included and re-formatted according to the EAU non-oncology template so that all Guidelines follow a similar format.

For this 2015 Guidelines, a complete text update was carried out involving a systematic literature search for articles in English language published in the PubMed, Medline, Web of Science, and Cochrane databases between 1966 and 31st December 2013. The search terms included ‘lower urinary tract symptoms’, ‘benign prostatic hyperplasia’, ‘detrusor overactivity’, ‘overactive bladder’, ‘nocturia’, and ‘nocturnal polyuria’, in combination with the pre-specified diagnostic tests, the various treatment modalities and the search limits, ‘humans’, ‘adult men’, ‘review’, ‘randomised clinical trials’, ‘clinical trials’, and ‘meta-analysis’.

2014

For this 2014 update, the Diagnostic chapter has been completely revised. The literature for all other chapters has been updated and additional data was included in the various overview tables.

2012

Updated literature search

New chapter on “Assessment”

2011

Added:
– Chapter 4 (Surgical treatment)The existing text was revisited