For the 2020 Management of Non-Neurogenic Male LUTS Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the Non-Neurogenic Male LUTS Guidelines was performed. The search was limited to studies representing high levels of evidence, i.e. systematic reviews with meta-analysis, randomised controlled trials (RCTs), and prospective non-randomised comparative studies, published in the English language. The scope search identified 1,254 unique references of which 228 full texts were reviewed resulting in 29 additional references and text updates being incorporated throughout the 2020 version of the Non-Neurogenic Male LUTS Guidelines. Specific changes include:
Chapter 5.3 Surgical treatment
- Section 5.3.1.1.1 - Updated recommendation for bipolar transurethral vaporisation of the prostate resulting in a change in strength rating.
| Recommendation | Strength rating |
| Offer bipolar transurethral vaporisation of the prostate as an alternative to monopolar TURP to surgically treat moderate-to-severe LUTS in men with prostate size of 30-80 mL. | Strong |
- Section 5.3.7 Techniques under investigation - recommendations for Aquablation and prostatic artery embolisation have been defined following a structured assessment of the available evidence.
| Summary of evidence | LE |
| Aquablation appears to be as effective as TURP both subjectively and objectively; however, there are still some concerns about the best methods of achieving post-treatment haemostasis | 1b |
| Recommendations | Strength rating |
| Offer Aquablation to patients with moderate-to-severe LUTS and prostates between 30 – 80 mL as an alternative to TURP. | Weak |
| Inform patients about the risk of bleeding and the lack of long-term follow up data. | Strong |
| Summary of evidence | LE |
| Prostatic artery embolisation is less effective than TURP at improving symptoms and urodynamic parameters such as flow rate. | 1a |
| Procedural time is longer for PAE compared to TURP but blood loss, catheterisation and hospitalisation time are in favour of PAE. | 1b |
| Recommendations | Strength rating |
| Offer prostatic artery embolisation (PAE) to men with moderate-to-severe LUTS who wish to consider minimally invasive treatment options and accept less optimal objective outcomes compared with transurethral resection of the prostate. | Weak |
| Perform PAE only in units where the work up and follow up is performed by urologists working collaboratively with trained interventional radiologists for the identification of PAE suitable patients. | Strong |