AUA 2019: AUA Guidelines Update: Surgical Management of BPH

Chicago, IL (UroToday.com) Dr. Parsons introduced AUA guideline amendment related to the surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). The purpose of the amendment was to provide a useful and evidence based reference for clinicians. Guideline update was conducted by the systematic review of current literature published from September 2017 to January 2019.

There were no changes to Statement 13 regarding photoselective vaporization of the prostate (PVP) as an option using 120W or 180W platforms for patients for the treatment of LUTS attributed to BPH. 

AUA Guidelines Statement 14 didn’t undergo any major changes. It covers a procedure of prostatic urethral lift (PUL). PUL is recommended as an option for patients with LUTS attributed to BPH with prostate volume <80g and verified absence of obstructive middle lobe; however, patients should be informed that symptom and flow rate improvement is less significant compared to TURP. Thus, patients have to be educated that evidence is poorly defined. AUA 2019 guidelines regarding PUL include one additional nonrandomized cohort stud

Statement 17 states that water vapor thermal therapy may be offered to the BPH patients provided prostate volume <80g, but patients had to be informed about known efficacy and retreatment rates. There were new efficacy data added on a 3-year follow up study, which indicates 39% in Qmax improvement and mean IPSS QOL improvement of 49%. Water vapor thermal therapy is also highlighted in Statement 18. This therapy is advised to eligible patients who desire preservation of erectile and ejaculatory function. This guideline didn’t undergo any significant changes, but some additional evidence was added to the text.

There is a new statement related to Aquablation therapy. It may be recommended to patients with LUTS related to BPH provided prostate volume is >30, but <80g; however, patients have to counseled about limited long-term evidence and retreatment rates. New items include information about robotic console, handpiece, and planning unit, transurethtral resection with water jet, and post-resection catheterization. One randomized control trial of 181 patients looked at aquablation vs. TURP, and these methods showed similar efficacy. However, aquablation was linked to decreased likelihood of worsened sexual function (p=0.03).

Prostate Artery Embolization (PAE) Statement 22 didn’t go through additional changes, but it was recommended to conduct multi-disciplinary studies and concider RCTs with sham control.

Medically Complicated Patients with BPH are offered HoLEP, PVP, and ThuLEP procedures due to high risk of bleeding. There were no major changes to the guideline with exception of additional evidence addition to the text. Future directions section didn’t go through any significant changes with some supporting evidence addition.

Presented by: J. Kellogg Parsons, MD, MHS; UC San Diego Moores Cancer Center

Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania @AStambakio at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

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