This is the current release of the guideline.

This guideline updates a previous version: American Urological Association, Inc. The management of benign prostatic hyperplasia. Baltimore (MD): American Urological Association, Inc.; 2003. Various p. [135 references]

Benign prostatic hyperplasia

Note: This guideline does not apply when other disease pathologies are known to be responsible for lower urinary tract symptoms (LUTS), such as prostate cancer or other genitourinary tract malignancies, or when LUTS are due to significant comorbidities (e.g., severe diabetes mellitus or neurologic disease), concomitant medications, urinary tract infections, prior pelvic surgery, or trauma.

Male patients aged 45 or older consulting a qualified healthcare provider for lower urinary tract symptoms

Management/Treatment

1. Information on the benefits and harms of benign prostatic hyperplasia (BPH) treatment options explained to patients considering interventional therapy
2. Watchful waiting for patients with mild, moderate, or severe lower urinary tract symptoms (LUTS) who are not bothered by their LUTS
3. Medical management
   • Alpha-adrenergic blockers
     • Alfuzosin
     • Doxazosin
     • Tamsulosin
     • Terazosin
   • 5-Alpha-reductase inhibitors (5-ARIs)
     • Dutasteride
     • Finasteride
   • Combination therapy
     • Alpha-blocker and 5-ARI
   • Anticholinergic agents
4. Minimally invasive therapies
   • Transurethral needle ablation
   • Transurethral microwave thermotherapy
5. Surgical procedures
   • Open prostatectomy
   • Laser therapies
     • Transurethral holmium laser ablation/enucleation of the prostate
     • Holmium laser resection of the prostate
     • Photoselective vaporization of the prostate
   • Transurethral incision of the prostate
   • Transurethral electrovaporization of the prostate
   • Transurethral resection of the prostate

Note: Laparoscopic or robotic prostatectomy was considered but there was insufficient published data on which to base a treatment recommendation. Complementary and alternative medicine therapies were also considered but not recommended.

Study Selection and Data Abstraction

To identify relevant citations, the American Urological Association (AUA) research librarian searched Ovid Medline® from January 1, 1999 through February 28, 2008. The search period overlapped with that of the prior AUA Guideline for Benign Prostatoc Hyperplasia (BPH) (2003) in order to capture any citations that were in the process of being indexed for Medline prior to June 30, 1999. The search strategy included the Medical Subject Headings (MeSH) for BPH and LUTS: "Prostatic Hyperplasia" [MesH] AND Benign NOT Case reports NOT Editorials NOT Comments NOT Abstracts NOT Letters to editor NOT Author replies (Limits: Entrez Date from 2006/06/01 to 2008/03/31, Humans, Male, English); "Urinary Tract" [MeSH] AND Symptoms AND Lower NOT Case reports NOT Editorials NOT Comments NOT Abstracts NOT Letters to editor NOT Author replies (Limits: Entrez Date from 2006/06/01 to 2008/04/22, Humans, Male, English).

Study inclusion and exclusion criteria (see Table 2.1 in the original guideline document) were determined by the Panel chair, Co-chair, and the methodologist in order to clearly define the scope and to achieve a reproducible and explicit process. All titles and abstracts from the bibliographic searches were reviewed by the Panel chair and the Co-chair, and the relevant articles were selected and then the full-text reviewed for inclusion. To update the search from January 2007 through February 2008, titles, abstracts, and full-text were dual reviewed by either the Panel chair or Co-chair and the methodologist, and consensus was achieved at the full-text level. Descriptive data were abstracted into Microsoft Word and numeric data into Microsoft Excel by a reviewer on the methodologist's staff and checked by a second reviewer. Abstracted data included study design, setting, population characteristics (including, age, AUA-Symptom Index [SI] score, Quality of Life [QoL] question, peak urine flow [Qmax; mL/sec], and for procedural studies, prostate volume and percentage of subjects in urinary retention) and details of the intervention (device, procedure, drug dosage and formulation). The Panel chair and Co-chair selected outcomes for abstraction and synthesis that were relevant to the clinician such as urinary flow and volume outcomes, as well as outcomes important to patients, such as symptoms and QoL. Also abstracted were data on adverse events for both pharmacotherapy and procedural interventions. For the latter, intraoperative, peri-operative, as well as short-term (<30 days) and longer-term adverse events were examined.

241 studies were included.

Not applicable

Data Synthesis

A qualitative analysis of the available evidence was performed on all interventions and outcomes. A narrative synthesis was presented, along with in-text tables summarizing important study and population characteristics, outcomes, and adverse events. Forest plots of study effect sizes were prepared when there were at least three to four points for an intervention. Studies were stratified by study design, comparator, follow-up interval, and intensity of intervention. Meta-analyses (quantitative synthesis) of outcomes of randomized controlled trials were planned; however, data were either sparse (i.e., there were small numbers of studies in certain categories), or not sufficiently homogeneous for the pooled effect to be meaningful.

The studies varied with respect to patient selection; randomization; blinding mechanism; run-in periods; patient demographics, comorbidities, prostate characteristics, and symptoms; drug doses; other intervention characteristics; comparators; rigor of follow-up; follow-up intervals; trial duration; timing of the trial; suspected lack of applicability to current practice in the United Sates; and techniques of outcomes measurement. These data limitations affected the quality of the materials available for review, making formal meta-analysis impractical or futile. Thus, the Panel and extractors were required to review the material in a systematic fashion rather than one with statistical rigor.

The clinical recommendations presented in this report are based on a systematic review and synthesis of the clinical literature on current and emerging therapies for the treatment of benign prostatic hyperplasia (BPH). The methodology follows the same process used in the development of the 2003 Guideline and, as such, did not include an evaluation of the strength of the body of evidence.

The expert Panel examined three overarching key questions for pharmacotherapeutic, surgical, and alternative medicine therapies:

1. What is the comparative efficacy and effectiveness of currently available and emerging treatments for BPH? What are the predictors of beneficial effects from treatments?
2. What are the adverse events associated with each of the included treatments and how do the adverse events compare across treatments?
3. Are there subpopulations in which the efficacy, effectiveness, and adverse event rates vary from those in general populations? Efficacy measures the extent to which an intervention produces a beneficial result under ideal conditions, such as clinical trials, whereas effectiveness measures the extent to which an intervention in ordinary conditions produces the intended result.

The treatment guideline was drafted by the Expert Panel based on the outcomes data and tempered by the Panel's expert opinion. As in the previous Guideline, the guideline statements were graded with respect to the degree of flexibility in their application. The three levels are essentially the same as in the previous guideline. A "standard" has the least flexibility as a treatment policy; a "recommendation" has significantly more flexibility; and an "option" is even more flexible. The three levels of flexibility were defined as standard, recommendation, and option.

Statements were graded using three levels with respect to the degree of flexibility in their application. A "standard" has the least flexibility as a treatment policy; a "recommendation" has significantly more flexibility; and an "option" is even more flexible. These three levels of flexibility are defined as follows:

1. Standard: A guideline statement is a standard if: (1) the health outcomes of the alternative interventions are sufficiently well known to permit meaningful decisions and (2) there is virtual unanimity about which intervention is preferred.
2. Recommendation: A guideline statement is a recommendation if: (1) the health outcomes of the alternative intervention are sufficiently well known to permit meaningful decisions, and (2) an appreciable but not unanimous majority agrees on which intervention is preferred.
3. Option: A guideline statement is an option if: (1) the health outcomes of the interventions are not sufficiently well known to permit meaningful decisions, or (2) preferences are unknown or equivocal. Options can exist because of insufficient evidence or because patient preferences are divided and may/should influence choices made.

A formal cost analysis was not performed and published cost analyses were not reviewed.

The draft was reviewed by the Panel, examined by 69 peer reviewers, and approved by the Practice Guidelines Committee and the Board of Directors of the American Urological Association (AUA).

Definitions of the strength of the recommendations (standard, recommendation and option) are defined at the end of the "Major Recommendations" field.

Diagnostic Evaluation

The Panel decided that the diagnostic section of the 2003 Guideline required updating. After review of the recommendations for diagnosis published by the 2005 International Consultation of Urologic Diseases and reiterated in 2009 in an article by Abrams et al. (2009), the Panel unanimously agreed that the contents were valid and reflected "best practices." The diagnostic guidelines by Abrams et al. (2009) are revisited in Appendix A7 of the original guideline document. Two treatment algorithms, one on the basic management of lower urinary tract symptoms (LUTS) in men and one on the detailed management for persistent bothersome LUTS, were adapted for this Guideline and are included in Appendix A7 of the original guideline document.

Basic Management

Not Recommended: The routine measurement of serum creatinine levels is not indicated in the initial evaluation of men with LUTS secondary to benign prostatic hyperplasia (BPH). [Based on review of the data and Panel consensus]

Detailed Management

If storage symptoms predominate, an overactive bladder due to idiopathic detrusor overactivity is the most likely cause if there is no indication of bladder outlet obstruction (BOO) from flow study. The treatment options of lifestyle intervention (fluid intake alteration), behavioral modification and pharmacotherapy (anticholinergic drugs) should be discussed with the patient.

It is the expert opinion of the Panel that some patients may benefit using a combination of all three modalities. Should improvement be insufficient and symptoms severe, then newer modalities of treatment such as botulinum toxin and sacral neuromodulation can be considered.

The patient should be followed to assess treatment success or failure and possible adverse events according to the section on basic management above.

Treatment Alternatives

Standard: Information on the benefits and harms of treatment alternatives for LUTS secondary to BPH should be explained to patients with moderate to severe symptoms (American Urological Association Symptom Index [AUA-SI] score ≥8) who are bothered enough to consider therapy. [Based on Panel consensus]

Table. Treatment Alternatives for Patients with Moderate to Severe Symptoms of BPH

*Silodosin was approved by the U.S. Food and Drug Administration (FDA), but there were no published articles in the peer reviewed literature prior to the cut-off date for the literature search.

Watchful Waiting

Standard: Patients with mild symptoms of LUTS secondary to BPH (AUA-SI score <8) and patients with moderate or severe symptoms (AUA-SI score ≥8) who are not bothered by their LUTS should be managed using a strategy of watchful waiting (active surveillance). [Based on review of the data and Panel consensus]

Medical Management

Alpha-adrenergic Blockers (Alpha-blockers)

Option: Alfuzosin, doxazosin, tamsulosin, and terazosin are appropriate and effective treatment alternatives for patients with bothersome, moderate to severe LUTS secondary to BPH (AUA-SI score ≥8). Although there are slight differences in the adverse events profiles of these agents, all four appear to have equal clinical effectiveness. As stated in the 2003 Guideline, the effectiveness and efficacy of the four alpha blockers under consideration appear to be similar. Although studies directly comparing these agents are currently lacking, the available data support this contention.* [Based on review of the data and Panel consensus]

*Silodosin was approved by the FDA, but there were no relevant published articles in the peer-reviewed literature prior to the cut-off date for the literature search.

Option: The older, less costly, generic alpha blockers remain reasonable choices. These require dose titration and blood pressure monitoring. [Based on Panel consensus]

Recommendation: As prazosin and the nonselective alpha-blocker phenoxybenzamine were not reviewed in the course of this Guideline revision, the 2003 Guideline statement indicating that the data were insufficient to support a recommendation for the use of these two agents as treatment alternatives for LUTS secondary to BPH has been maintained. [Based on Panel consensus]

Option: The combination of an alpha-blocker and a 5-alpha reductase inhibitor (5-ARIs) (combination therapy) is an appropriate and effective treatment for patients with LUTS associated with demonstrable prostatic enlargement based on volume measurement, prostate-specific antigen (PSA) level as a proxy for volume, and/or enlargement on digital rectal exam (DRE). [Based on review of the data and Panel consensus]

Intraoperative Floppy Iris Syndrome

Recommendation: Men with LUTS secondary to BPH for whom alpha-blocker therapy is offered should be asked about planned cataract surgery. Men with planned cataract surgery should avoid the initiation of alpha-blockers until their cataract surgery is completed. [Based on review of the data and Panel consensus]

Recommendation: In men with no planned cataract surgery, there are insufficient data to recommend withholding or discontinuing alpha-blockers for bothersome LUTS secondary to BPH. [Based on review of the data and Panel consensus]

5-ARIs

Option: 5-ARIs may be used to prevent progression of LUTS secondary to BPH and to reduce the risk of urinary retention and future prostate-related surgery. [Based on review of the data and Panel consensus]

Recommendation: 5-ARIs should not be used in men with LUTS secondary to BPH without prostatic enlargement. [Based on review of the data and Panel consensus]

Option: The 5-ARIs are appropriate and effective treatment alternatives for men with LUTS secondary to BPH who have demonstrable prostate enlargement. [Based on review of the data and Panel consensus]

5-ARIs for Other Indications

Hematuria

Option: Finasteride is an appropriate and effective treatment alternative in men with refractory hematuria presumably due to prostatic bleeding (i.e., after exclusion of any other causes of hematuria). A similar level of evidence concerning dutasteride was not reviewed; it is the expert opinion of the Panel that dutasteride likely functions in a similar fashion. [Based on review of the data and Panel consensus]

Prevention of Bleeding During Transurethral Resection of the Prostate (TURP)

Option: Overall, there is insufficient evidence to recommend using 5-ARIs preoperatively in the setting of a scheduled TURP to reduce intraoperative bleeding or reduce the need for blood transfusions. [Based on review of the data and Panel consensus]

Anticholinergic Agents

Option: Anticholinergic agents are appropriate and effective treatment alternatives for the management of LUTS secondary to BPH in men without an elevated post-void residual and when LUTS are predominantly irritative. [Based on Panel consensus]

Recommendation: Prior to initiation of anticholinergic therapy, baseline PVR urine should be assessed. Anticholinergics should be used with caution in patients with a post-void residual greater than 250 to 300 mL. [Based on Panel consensus]

Complementary and Alternative Medicines (CAM)

Recommendation: No dietary supplement, combination phytotherapeutic agent or other nonconventional therapy is recommended for the management of LUTS secondary to BPH. [Based on review of the data and Panel consensus]

Recommendation: At this time, the available data do not suggest that saw palmetto has a clinically meaningful effect on LUTS secondary to BPH. Further clinical trials are in progress and the results of these studies will elucidate the potential value of saw palmetto extracts in the management of patients with BPH. [Based on review of the data and Panel consensus]

Recommendation: The paucity of published high quality, single extract clinical trials of Urtica dioica do not provide a sufficient evidence base with which to recommend for or against its use for the treatment of LUTS secondary to BPH. [Based on review of the data and Panel consensus]

Minimally Invasive Therapies

Standard: Safety recommendations for the use of transurethral needle ablation of the prostate (TUNA) and transurethral microwave thermotherapy (TUMT) published by the FDA should be followed: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/default.htm . [Based on review of the data]

TUNA of the Prostate

Option: TUNA of the prostate is an appropriate and effective treatment alternative for bothersome moderate or severe LUTS secondary to BPH. [Based on review of the data and Panel consensus]

TUMT

Option: TUMT is effective in partially relieving LUTS secondary to BPH and may be considered in men with moderate or severe symptoms. [Based on review of the data and Panel consensus]

Surgical Procedures

Recommendation: Surgery is recommended for patients who have renal insufficiency secondary to BPH, who have recurrent UTIs, bladder stones or gross hematuria due to BPH, and those who have LUTS refractory to other therapies. The presence of a bladder diverticulum is not an absolute indication for surgery unless associated with recurrent UTI or progressive bladder dysfunction. [Based on review of the data and Panel consensus.]

Open Prostatectomy

Option: Open prostatectomy is an appropriate and effective treatment alternative for men with moderate to severe LUTS and/or who are significantly bothered by these symptoms. The choice of approach should be based on the patient's individual presentation including anatomy, the surgeon's experience, and discussion of the potential benefit and risks for complications. The Panel noted that there is usually a longer hospital stay and a larger loss of blood associated with open procedures. [Based on review of the data and Panel consensus.]

Laser Therapies

Option: Transurethral laser enucleation (holmium laser resection of the prostate [HoLRP], holmium laser enucleation of the prostate [HoLEP]), transurethral side firing laser ablation (holmium laser ablation of the prostate [HoLAP], and photoselective vaporization [PVP]) are appropriate and effective treatment alternatives to transurethral resection of the prostate and open prostatectomy in men with moderate to severe LUTS and/or those who are significantly bothered by these symptoms. The choice of approach should be based on the patient's presentation, anatomy, the surgeon's level of training and experience, and a discussion of the potential benefit and risks for complications. Generally, transurethral laser approaches have been associated with shorter catheterization time and length of stay, with comparable improvements in LUTS. There is a decreased risk of the perioperative complication of transurethral resection syndrome. Information concerning certain outcomes, including retreatment and urethral strictures, is limited due to short follow-up. As with all new devices, comparison of outcomes between studies should be considered cautiously given the rapid evolution in technologies and power levels. Emerging evidence suggests a possible role of transurethral enucleation and laser vaporization as options for men with very large prostates (>100 g). There are insufficient data on which to base comments on bleeding. [Based on review of the data and Panel consensus.]

Transurethral Incision of the Prostate (TUIP)

Option: TUIP is an appropriate and effective treatment alternative in men with moderate to severe LUTS and/or who are significantly bothered by these symptoms when prostate size is less than 30 mL. The choice of approach should be based on the patient's individual presentation including anatomy, the surgeon's experience and discussion of the potential benefits and risks for complications. [Based on review of the data and Panel consensus.]

Transurethral Electrovaporization of the Prostate (TUVP)

Option: TUVP is an appropriate and effective treatment alternative in men with moderate to severe LUTS and/or who are significantly bothered by these symptoms. The choice of approach should be based on the patient's individual presentation including anatomy, the surgeon's experience and discussion of the potential benefit and risks for complications. [Based on review of the data and Panel consensus.]

TURP

Option: TURP is an appropriate and effective primary alternative for surgical therapy in men with moderate to severe LUTS and/or who are significantly bothered by these symptoms. The choice of a monopolar or bipolar approach should be based on the patient's presentation, anatomy, the surgeon's experience and discussion of the potential risks and likely benefits. [Based on review of the data and Panel consensus]

Option: Overall, there is insufficient evidence to recommend using 5-ARIs in the setting of a pre-TURP to reduce intraoperative bleeding or reduce the need for blood transfusions. [Based on review of the data and Panel consensus]

Laparoscopic and Robotic Prostatectomy

Option: Men with moderate to severe LUTS and/or who are significantly bothered by these symptoms can consider a laparoscopic or robotic prostatectomy. There are insufficient published data on which to base a treatment recommendation. [Based on review of the data and Panel consensus]

Definitions:

Standard: A guideline statement is a standard if: (1) the health outcomes of the alternative interventions are sufficiently well known to permit meaningful decisions and (2) there is virtual unanimity about which intervention is preferred.

Recommendation: A guideline statement is a recommendation if: (1) the health outcomes of the alternative intervention are sufficiently well known to permit meaningful decisions, and (2) an appreciable but not unanimous majority agrees on which intervention is preferred.

Option: A guideline statement is an option if: (1) the health outcomes of the interventions are not sufficiently well known to permit meaningful decisions, or (2) preferences are unknown or equivocal. Options can exist because of insufficient evidence or because patient preferences are divided and may/should influence choices made.

Algorithms are provided in Appendix A7 in the original guideline document for:

• Basic management of lower urinary tract symptoms (LUTS) in men
• Detailed management of persistent bothersome LUTS after basic management

The type of supporting evidence is not specifically stated for each recommendation.

The clinical guideline statements presented in this document were based on a systematic review and synthesis of the clinical literature on current and emerging therapies on this topic and on expert opinion and consensus when evidence was lacking.

Appropriate management of lower urinary tract symptoms in men with benign prostatic hyperplasia to alleviate symptoms, minimize complications of treatment, and improve quality of life

An implementation strategy was not provided.

Diagnostic guidelines are provided in an algorithm in Appendix A7 of the original guideline document. These recommendations are adapted by the Panel from the following sources:

Male lower urinary tract dysfunction: evaluation and management. In: 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases. Edited by J. McConnell, P. Abrams, L. Denis et al. Paris, France: Health Publications, 2006.

Abrams P, Chapple C, Khoury S et al: Evaluation and treatment of lower urinary tract symptoms in older men. J Urol 2009; 181: 1779.

American Urological Association, Inc. (AUA)

BPH Guideline Update Panel (2010)

Panel Members: Kevin T. McVary, M.D. (Chair), Northwestern University Feinberg School of Medicine, Chicago, IL; Claus G. Roehrborn, M.D. (Co-Chair), UT Southwestern Medical Center at Dallas, Dallas, TX; Andrew Avins, M.D., MPH, Kaiser Permanente Northern California, Division of Research, Oakland, CA; Michael J. Barry, M.D., Massachusetts General Hospital, Boston, MA; Reginald C. Bruskewitz, M.D., University of Wisconsin Medical School, Madison, WI; Robert F. Donnell, M.D., Medical College of Wisconsin, Milwaukee, WI; Harris E. Foster, Jr., M.D., Yale University School of Medicine, New Haven, CT; Chris M. Gonzalez, M.D., Northwestern University, Feinberg School of Medicine, Chicago, IL; Steven A. Kaplan, M.D., New York University School of Medicine, New York, NY; David F. Penson, MD, MPH, Vanderbilt University Medical Center, VA Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN; James C. Ulchaker, M.D., Cleveland Clinic Foundation, Cleveland, OH; John T. Wei, M.D., University of Michigan Medical Center, Ann Arbor, MI

Consultants: Susan Norris, MD, MPH, MSc; Suzanne Pope, MBA; Natalie Jacuzzi, MPH; Tarra McNally, MA, MPH; Veronica Ivey; Ben Chan, MS; Diann Glickman, PharmD

All panel members completed Conflict of Interest disclosures. Those marked with (C) indicate that compensation was received; relationships designated by (U) indicate no compensation was received.

Board Member, Officer, Trustee: Michael J. Barry, Foundation for Informed Medical Decision Making(C)

Consultant or Advisor: Kevin T. McVary, Eli Lilly(C), Allergan(C), Watson Pharmaceuticals(C), Neotract(C), Ferring(C); Reginald C. Bruskewitz, Urologix(C), Neotract(C); Claus G. Roehrborn, American Medical Systems(C), GlaxoSmithKline(C), Lilly(C), Neotract(C), Neri(C), NxThera(C), Pfizer(C), Warner Chilcot(C), Watson(C); Steven A. Kaplan, Pfizer,(C), Astellas(C), Watson(C), Neotract(C)

Investigator: Kevin T. McVary, NIDDK(C), Lilly/ICOS(C), Allergan(C); Robert F. Donnell, National Cancer Institute(C), NIH(C), EDAP (U); James C. Ulchaker, American Medical Systems(C); Claus G. Roehrborn, American Medical Systems(C), BPH Registry/Univ. of Michigan, Lilly(C)

Lecturer: Kevin T. McVary, GlaxoSmithKline (C), Lilly/ICOS(C), Sanofi-Aventis(C), Advanced Health Media(C); Steven A. Kaplan, GlaxoSmithKline(C); James C. Ulchaker, GlaxoSmithKline(C), Astellas Pharma US, Inc.(C); Claus G. Roehrborn, GlaxoSmithKline(C), Watson(C)

Medical Director: James C. Ulchaker, Fortec Medical(C)

Scientific Study or Trial: Reginald C. Bruskewitz, NIDDK(C); Robert F. Donnell, Allergan(C), RTOG (U), Astra Zeneca(C); Steven A. Kaplan, NIH(C), NIDDK(C), Claus G. Roehrborn, American Medical Systems(C), BPH Registry/Univ. of Michigan(C), GlaxoSmithKline(C), Lilly(C), Neri(C), Pfizer(C)

Other: Christopher M. Gonzalez, Aurasense, Investment Interest (U), Coloplast, Gift for reconstruction fellowship program(C), Wolf, Gift for international surgical relief fund(C)

This is the current release of the guideline.

This guideline updates a previous version: American Urological Association, Inc. The management of benign prostatic hyperplasia. Baltimore (MD): American Urological Association, Inc.; 2003. Various p. [135 references]

Electronic copies: Available in from the American Urological Association, Inc. (AUA) Web site .

The following forms are available in the appendices  of the original guideline document:

• Benign Prostatic Hyperplasia (BPH) Impact Index
• American Urological Association Symptom Index for BPH/International Prostate Symptom Score (AUA-SI/IPSS)

The following are available:

• Management of benign prostatic hyperplasia (BPH). Linthicum (MD): American Urological Association (AUA) Education and Research, Inc. 2011 Jan. Electronic copies: Available in PDF from the AUA Foundation Web site .
• Diagnosis of BPH. Linthicum (MD): American Urological Association (AUA) Education and Research, Inc.; 2006 Nov. Electronic copies: Available from the AUA Foundation Web site .
• Medical management of BPH. Linthicum (MD): American Urological Association (AUA) Education and Research, Inc.; 2010 Feb. Electronic copies: Available from the AUA Foundation Web site .
• Minimally invasive management of BPH. Linthicum (MD): American Urological Association (AUA) Education and Research, Inc.; 2006 Nov. Electronic copies: Available from the AUA Foundation Web site .
• Surgical management of BPH. Linthicum (MD): American Urological Association (AUA) Education and Research, Inc.; 2008 Jan. Electronic copies: Available from the AUA Foundation Web site .

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

This NGC summary was completed by ECRI on June 24, 2003. The information was verified by the guideline developer on August 25, 2003. This summary was updated by ECRI on November 30, 2005 following the U.S. Food and Drug Administration (FDA) advisory on Flomax. The information was reaffirmed by the guideline developer on September 28, 2009 and updated by ECRI Institute on March 29, 2010. This NGC summary was updated by ECRI Institute on April 18, 2011. The updated information was verified by the guideline developer on May 9, 2011. This summary was updated by ECRI Institute on June 16, 2011 following the FDA advisory on 5-alpha reductase inhibitors (5-ARIs).

This NGC summary is based on the original guideline, which is copyrighted by the American Urological Association, Inc. (AUA).