Guidelines

Management of Non-neurogenic Male LUTS

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2. METHODS

2.1. Introduction

For the 2023 Non-Neurogenic Male LUTS Guidelines, a forensic review and restructure of Section 5.3 - Surgical treatment, was undertaken. An assessment of all newly published literature will be performed for the 2024 Non-Neurogenic Male LUTS Guidelines.

Detailed search strategies for the 2022 guideline update are available online: https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/publications-appendices

For each recommendation within the guidelines there is an accompanying online strength rating form which includes the assessment of the benefit to harms ratio and patients ‘preferences for each recommendation. The strength rating forms draws on the guiding principles of the GRADE methodology but do not purport to be GRADE [1,2]. Each strength rating form addresses a number of key elements namely:

  1. the overall quality of the evidence which exists for the recommendation, references used in this text are graded according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence [3];
  2. the magnitude of the effect (individual or combined effects);
  3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
  4. the balance between desirable and undesirable outcomes;
  5. the impact of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’ [4]. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences.

Additional information can be found in the general Methodology section of this print, and online at the EAU website; http://www.uroweb.org/guideline/. A list of associations endorsing the EAU Guidelines can also be viewed online at the above address.

2.2. Review

The Non-Neurogenic Male LUTS Guidelines were peer reviewed prior to publication in 2016. The newly added section on management of urinary incontinence in males was peer reviewed prior to the publication in 2022.

2.3. Patients to whom the guidelines apply

Recommendations apply to men aged 40 years or older who seek professional help for LUTS in various non-neurogenic and non-malignant conditions such as BPO, detrusor overactivity (DO)/overactive bladder (OAB), or nocturnal polyuria (NP). Men with other associated factors relevant to LUT disease (e.g., concomitant neurological diseases, young age, prior LUT disease or surgery) usually require a more extensive work-up, which is not covered in these Guidelines, but may include several tests mentioned in the following sections. EAU Guidelines on Neuro-Urology, Urological Infections, Urolithiasis, or malignant diseases of the LUT have been developed by other EAU Guidelines Panels and are available online: www.uroweb.org/guidelines/.