Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2020. Letter.

You have accessJournal of UrologyLetters to the Editor1 Mar 2021Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2020. Letter. Paul Abrams Paul AbramsPaul Abrams † E-mail Address: [email protected] Bristol Urological Institute, Bristol, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail J Urol 2020; 204: 799. To the Editor: Unfortunately, the 2020 amendment1 to the 2019 AUA (American Urological Association) Guideline on the “Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia” (BPH), has not addressed the inconsistencies of the Guideline.2 The Guideline states that BPH is a histological diagnosis, BPH in itself does not require treatment and is not the target of therapeutic intervention, and that “BPH is nearly ubiquitous in the aging male with worldwide autopsy proven histological prevalence increases starting at age 40-45 years to reach 60% at age 60 and 80% at age 80.” The Guideline makes it clear that progression is by no means inevitable: “It is important to realize that not all men with BPE [benign prostatic enlargement] will develop obstruction or BPO [benign prostatic obstruction], just as not all men with BPH will have BPE.” Hence the use of BPH in the title is inappropriate, and will be an issue for both patients and urologists charged with their care. The Guideline also includes the contradictory statement, “In this guideline, the Panel refers to “LUTS [lower urinary tract symptoms] attributed to BPH” to indicate LUTS among older men for whom an alternative cause is not apparent after a basic evaluation.” However, there are no LUTS indicative of histological BPH, or indeed BPO, and the Guideline rightly points this out by saying that LUTS lack diagnostic specificity for BPO, which is the target of intervention: “It is important to recognize that LUTS are non-specific, [and] occur in men and women with similar frequency,” and this has been known for a considerable period of time.3 The Guideline also highlights the lack of diagnostic specificity, not only of LUTS, but also of the measurement of post void residual and maximum urine flow rate, whilst stating that pressure flow studies are the best way to diagnose obstruction. The Guideline provides a lot of useful and accurate data and commentary to the Guideline Statements. For example, “Flow rates of <10 mL/s have shown a specificity of 70%, a positive predictive value of 70%, and a sensitivity of 47% for BOO [bladder outlet obstruction]. If the patient's condition is not sufficiently suggestive of obstruction (eg, peak urinary flow [Qmax] >10 mL/sec), pressure flow studies are optional as treatment failure rates are somewhat higher in the absence of obstruction.” It is clear that the existing Guideline title is inaccurate, confusing due to inconsistent use of terminology, and has very little intuitive meaning. A number of possible titles would bring transparency to this situation, such as: “The management of male LUTS,” or “The surgical management of LUTS suggestive of BPO.” It is hoped that the AUA will consider an early further amendment to the 2019 Guideline to correct these inconsistencies. Sincerely, Paul Abrams Bristol Urological Institute Bristol, United Kingdom email: paul.[email protected]ac.uk References 1. : Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2020. J Urol 2020; 204: 799. Link, Google Scholar 2. : Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2019. J Urol 2019; 202: 592. Link, Google Scholar 3. : Comparison of the AUASI in unselected males and females between the ages of 55-79 years of age. Urology 1993; 42: 36. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 205Issue 3March 2021Page: 938-938 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Abrams Bristol Urological Institute, Bristol, United Kingdom † E-mail Address: [email protected] More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...