[CONDITIONAL recommendation, EXPERT OPINION evidence] [Conditional recommendation] 5-ARIs may be considered as a treatment option to reduce intraoperative and postoperative bleeding after TURP or other surgeries for BPH. [Expert opinion] Based on expert consensus.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] Tadalafil 5mg daily should be discussed as a treatment option for patients with LUTS/BPH, irrespective of comorbid ED. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] The combination of low-dose daily tadalafil 5mg with alpha blockers may be offered for the treatment of LUTS/BPH. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] The combination of low-dose daily tadalafil 5mg with finasteride may be offered for the treatment of LUTS/BPH. [Low evidence] Based on Grade C evidence.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] An oral alpha blocker should be prescribed prior to a voiding trial for patients with acute urinary retention related to BPH. [Moderate evidence] Based on Grade B evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Surgery is recommended for patients with BPH who have complications such as renal insufficiency, refractory urinary retention, recurrent UTIs, bladder stones, gross hematuria, or LUTS refractory to other therapies. [Expert opinion] Based on clinical principles.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] TURP should be offered as a treatment option for patients with LUTS/BPH. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, MODERATE evidence] [Conditional recommendation] Bipolar TUVP may be offered as an option for the treatment of LUTS/BPH. [Moderate evidence] Based on Grade B evidence.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] PVP using 120W or 180W platforms should be offered as an option for the treatment of LUTS/BPH. [Moderate evidence] Based on Grade B evidence.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] PUL should be considered as a treatment option for patients with LUTS/BPH who have prostate volume 30-80g and no obstructive middle lobe. [Low evidence] Based on Grade C evidence.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] WVTT should be considered as a treatment option for patients with LUTS/BPH who have prostate volume 30-80g. [Low evidence] Based on Grade C evidence.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] HoLEP or ThuLEP should be considered as options for the treatment of LUTS/BPH, regardless of prostate size, depending on clinician expertise. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] RWT may be offered as a treatment option for patients with LUTS/BPH who have prostate volume 30-80g. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] PAE may be offered for the treatment of LUTS/BPH, performed by trained clinicians after discussing risks and benefits. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, EXPERT OPINION evidence] [Conditional recommendation] TIPD may be offered as a treatment option for patients with LUTS/BPH who have prostate volume 25-75g and no obstructive median lobe. [Expert opinion] Based on expert consensus.
[WEAK recommendation] Clinicians may offer initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies to patients with BPH and bothersome OAB, in shared decision-making. [EXPERT OPINION evidence] This is based on expert opinion.
[CONDITIONAL recommendation] Clinicians may offer monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic or beta-3 agonist, to patients with BPH and OAB. [MODERATE evidence] This is based on single randomized controlled trials or strong observational studies.
[MODERATE recommendation] Clinicians should obtain a medical history, conduct a physical exam, use the IPSS, and perform a urinalysis. [EXPERT OPINION evidence] Based on clinical principles.
[MODERATE recommendation] Patients should be counselled on options including behavioral modifications, medical therapy, or referral. [EXPERT OPINION evidence] Based on expert consensus.
[MODERATE recommendation] Patients should be evaluated 4-12 weeks after treatment initiation, including IPSS, and optionally PVR and uroflowmetry. [EXPERT OPINION evidence] Based on clinical principles.
[MODERATE recommendation] Patients should undergo further evaluation and consider changing management or surgical intervention. [EXPERT OPINION evidence] Based on expert consensus.
[MODERATE recommendation] Clinicians should consider assessment via ultrasound, cystoscopy, or cross-sectional imaging. [EXPERT OPINION evidence] Based on clinical principles.
[MODERATE recommendation] Clinicians should perform a PVR assessment prior to intervention. [EXPERT OPINION evidence] Based on clinical principles.
[MODERATE recommendation] Clinicians should consider uroflowmetry prior to intervention. [EXPERT OPINION evidence] Based on clinical principles.
[MODERATE recommendation] Clinicians should consider pressure flow studies when diagnostic uncertainty exists. [EXPERT OPINION evidence] Based on expert consensus.
[MODERATE recommendation] Clinicians should inform patients of treatment failure possibilities and need for additional treatments. [EXPERT OPINION evidence] Based on clinical principles.
[MODERATE recommendation] Clinicians should offer alpha blockers such as alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin. [HIGH evidence] Based on multiple RCTs with consistent results.
[STRONG recommendation, HIGH evidence] [Strong recommendation] Combination therapy with a 5-ARI and an alpha blocker should be offered as a treatment option only for patients with LUTS and demonstrable prostatic enlargement (e.g., prostate volume >30g, PSA >1.5ng/mL). [High evidence] Based on Grade A evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Anticholinergic agents, alone or with alpha blockers, may be offered as a treatment option for patients with moderate to severe predominant storage LUTS. [Low evidence] Based on Grade C evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Surgery should not be performed solely for an asymptomatic bladder diverticulum; however, evaluation for bladder outlet obstruction should be considered. [Expert opinion] Based on clinical principles.
[CONDITIONAL recommendation, EXPERT OPINION evidence] [Conditional recommendation] 5-ARIs may be an appropriate and effective treatment alternative for men with refractory hematuria presumably due to prostatic bleeding, after excluding other causes. [Expert opinion] Based on expert consensus.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should manage patients with stress urinary incontinence after treatment of benign prostatic hyperplasia the same as patients that have undergone radical prostatectomy. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[Conditional recommendation] Clinicians may offer initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies, based on shared decision-making. [Expert opinion] This is based on expert opinion.
[Conditional recommendation] Clinicians should offer monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic medication or beta-3 agonist. [Moderate evidence] This is based on moderate-quality evidence (Grade B).
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should inform patients who pass a successful trial without catheter for acute urinary retention due to BPH that they remain at increased risk for recurrent retention. [Low evidence] Based on Grade C evidence.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] TUIP should be offered as an option for patients with prostates ≤30g for the surgical treatment of LUTS/BPH. [Moderate evidence] Based on Grade B evidence.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] HoLEP, PVP, and ThuLEP should be considered as treatment options for patients with LUTS/BPH who are at higher risk of bleeding. [Expert opinion] Based on expert consensus.