Evidence-based guidelines in lower urinary tract symptoms secondary to benign prostatic hyperplasia and variation in...

Guidelines have been developed to assist physicians in the diagnosis and management of patients with lower urinary tract symptoms. These guidelines vary in the level of evidence used and the strength of their recommendations. With variations in guidelines, multiple variations in clinical practice may also been seen.

Although examinations of physician compliance with benign prostatic hyperplasia (BPH) guidelines date back to the 1980s, researchers have become more interested in closer examination of guideline compliance. Furthermore, guidelines themselves are becoming more robust documents, with the American Urological Association and European Association of Urology guidelines updated in 2014 and 2015, respectively. This review examines both the evidence base behind these BPH guidelines and the variations in clinical care related to the guidelines.

Despite over 40 years of study, variations continue to occur in the work up and treatment of men with BPH. With the proliferation of medications and surgical procedures available for symptomatic lower urinary tract symptoms (LUTS) due to BPH, we will continue to see this variation in care. Our current guidelines can help mitigate this variation by providing a baseline set of assessments and algorithms for routine patients. However, only through continued refinement will the guidelines meet their full potential. The prior review shows how the evidence base is limited for the diagnostic work up for LUTS, provides limited information on comparative effectiveness of therapies in LUTS and BPH, and has not led to consistency between guidelines.