Surgical treatment of lower urinary tract symptoms secondary to benign prostatic obstruction: an analysis and meta-synthesis of available guidelines

Abstract

PURPOSE: The increase in minimally invasive treatments (MITs) for lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) has diversified surgical options, often outpacing solid evidence. The variety of available treatments, while beneficial, can confound physicians. Clinical guidelines provide direction but often differ due to varied evidence interpretation. METHODS: We have analyzed the available guidelines on the surgical treatment of LUTS/BPO updated within the last three years, focusing on those offering specific procedural recommendations. We compared recommendations, analyzed discrepancies, and developed a consensus algorithm that incorporated all pertinent advice. RESULTS AND LIMITATIONS: Out of 14 guidelines, four met the inclusion criteria. Major challenges were inconsistent nomenclature and a lack of clear recommendations, especially for newer procedures such as Temporary Implantable Nitinol Device (iTIND™), Prostate Artery Embolization (PAE), Robotic Assisted Simple Prostatectomy (RASP), and Water Vapor Thermal Therapy (Rezūm™). Despite these issues, a consensus algorithm could be synthesized. CONCLUSIONS AND CLINICAL IMPLICATIONS: Guidelines for the treatment of LUTS/BPO present a disparate picture, with consensus mostly on older, well-established procedures due to substantial evidence. Newer interventions display significant variation in guideline recommendations and evidence interpretation. The consensus algorithm created from current guidelines offers a synthesized overview of recommendations, underscoring the need for standardized evidence criteria for guideline recommendations. Our work emphasizes the evolving complexity in LUTS/BPO management, aiming to aid urologists in decision-making and patient counseling by providing a clear and comprehensive tool.