Benign prostatic hyperplasia (BPH) refers to the proliferation of glandular and stromal components within the transition zone of the prostate. Non-neurogenic lower urinary tract symptoms (LUTS) can be due to bladder, prostate, urethral, or other pathology. Bothersome LUTS is the main reason patients seek treatment and generally drives management decisions. As such, shared decision-making plays a critical role in the initiation and escalation of treatment. This Guideline covers the evaluation and treatment of LUTS/BPH. The summary presented herein represents Part I of the three-part series dedicated to Management of LUTS/BPH. Please refer to Parts II and III and the full version of the Guideline for additional information on this topic.
The systematic review that informs this Guideline was based on searches in Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through January 2025. Update searches were conducted on December 15, 2025. Literature searches were limited to studies of medical therapies published since 2009 and surgical studies published since 2014. The searches were supplemented by reviewing electronic database reference lists of relevant articles. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest developed by the Panel.
The recommendations herein address initial presentation, evaluation, and initial management of patients with LUTS/BPH. Where possible, evidence levels were assigned along with relevant supporting text to assist clinicians when encountering men with LUTS/BPH. Standard evaluation is established with appropriate tests and shared decision-making.
The presentation, evaluation, and initial management of patients presenting with LUTS/BPH is straightforward. In addition to patient history and physical examination, the recommendations herein include the appropriate use of tests and patient counseling.
The Journal of urology. 2026 May 07 [Epub ahead of print]
Ramy Goueli, Gopal H Badlani, Charles Welliver, Paul D Anderson, Scott R Bauer, Tracy Dana, Rodrigo Donalisio da Silva, Rebecca Holmes, Sennett K Kim, Erin Kirkby, Steven Maislos, Bradley C Gill, Timothy McClure, Nicole L Miller, Iraj Roshan, Stephen J Summers, Annette Totten, Jaspreet S Sandhu
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas., Department of Urology, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina., Department of Urology, Albany Medical College, Albany, New York., Department of Urology, Royal Melbourne Hospital, Victoria, Australia., Division of General Internal Medicine, University of California San Francisco, San Francisco, California., Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon., Department of Surgery, Division of Urology, University of Texas Houston McGovern Medical School, Houston, Texas., American Urological Association, Linthicum, Maryland., Department of Urology, Urology Institute of Houston, Houston, Texas., Department of Urology, Cleveland Clinic, Cleveland, Ohio., Department of Urology and Radiology, Weill Cornell Medicine, New York, New York., Department of Urology, Vanderbilt Health, Nashville, Tennessee., Flint, Texas., Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah., Department of Surgery, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York.