SAN FRANCISCO—Coinciding with its annual meeting, the American Urological Association released new clinical guidelines for the surgical management of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH).
Included among the guidelines' 22 recommended treatment options are some of the newer forms of minimally invasive treatments, including prostatic urethral lift (PUL) and water vapor thermal therapy.
According to the recommendations, clinicians should consider as options for treating BPH-related LUTS:
transurethral resection of the prostate (TURP).
open, laparoscopic, or robotic assisted prostatectomy, depending on their expertise.
photoselective vaporization of the prostate (PVP) using 120W or 180W platform.
PUL for patients with prostates smaller than 80 grams and verified absence of an obstructive middle lobe.
holmium or thulium laser enucleation of the prostate, depending on their expertise with either technique.
holmium and thulium laser enucleation of the prostate and PVP for patients at higher risk of bleeding, such as those on anticoagulation drugs.
In addition, the guidelines state that clinicians may use a monopolar or bipolar approach to TURP, depending on their expertise. They also may offer water vapor thermal therapy to patients with prostates smaller than 80 grams, although patients should be informed that evidence of efficacy, including longer-term retreatment rates, remain limited.