Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II - Surgical Evaluation and Treatment

Lori B. Lerner, Kevin T. McVary, Michael J. Barry, Brooke R. Bixler, Philipp Dahm, Anurag Kumar Das, Manhar C. Gandhi, Steven A. Kaplan, Tobias S. Kohler, Leslie Martin, J. Kellogg Parsons, Claus G. Roehrborn, John T. Stoffel, Charles Welliver, Timothy J. Wilt

Research output: Contribution to journalReview articlepeer-review

133 Scopus citations


Purpose: Surgical therapies for symptomatic bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) are many, and vary from minimally invasive office based to high-cost operative approaches. This Guideline presents effective evidence-based surgical management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). See accompanying algorithm for a detailed summary of procedures (figure Figure. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia). Materials/Methods: The Minnesota Evidence Review Team searched Ovid MEDLINE, Embase, Cochrane Library, and AHRQ databases to identify eligible studies published between January 2007 and September 2020, which includes the initial publication (2018) and amendments (2019, 2020). The Team also reviewed articles identified by Guideline Panel Members. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, information is provided as Clinical Principles and Expert Opinions (tableTable.AUA Nomenclature Linking Statement Type to Level of Certainty, Magnitude of Benefit or Risk/Burden, and Body of Evidence Strength). Results: Twenty-four guideline statements pertinent to pre-operative and surgical management were developed. Appropriate levels of evidence and supporting text were created to direct urologic providers towards suitable and safe operative interventions for individual patient characteristics. A re-treatment section was created to direct attention to longevity and outcomes with individual approaches to help guide patient counselling and therapeutic decisions. Conclusion: Pre-operative and surgical management of BPH requires attention to individual patient characteristics and procedural risk. Clinicians should adhere to recommendations and familiarize themselves with criteria that yields the highest likelihood of surgical success when choosing a particular approach for a particular patient.

Original languageEnglish (US)
Pages (from-to)818-826
Number of pages9
JournalJournal of Urology
Issue number4
StatePublished - Oct 2021

Bibliographical note

Funding Information:
AUA would like to thank the Minnesota Evidence Review Team (Timothy J. Wilt, MD and Philipp Dahm, MD) for the development of the evidence report that was used to aid in the creation of this guideline.

Publisher Copyright:
Copyright © 2021 American Urological Association Education and Research, Inc.


  • BPH
  • HoLEP
  • LUTS
  • MIST
  • PUL
  • PVP
  • Prostate surgery
  • TUIP
  • TUMT
  • TURP
  • TUVP
  • ThuLEP
  • aquablation
  • open prostatectomy
  • robotic assisted simple prostatectomy
  • simple prostatectomy
  • water vapor thermal therapy


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