title: EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction.
abstract: OBJECTIVE
  To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS).
  
  
  METHODS
  We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality.
  
  
  RESULTS
  Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental.
  
  
  CONCLUSIONS
  These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/pdf/12_Male_LUTS.pdf).
authors.affiliation: Department of Urology, Hannover Medical School, Hannover, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Oelke
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.forename: Aurélien
authors.initials: A
authors.lastname: Descazeaud
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.forename: Martin C
authors.initials: MC
authors.lastname: Michel
authors.forename: James
authors.initials: J
authors.lastname: N'dow
authors.forename: Jørgen
authors.initials: J
authors.lastname: Nordling
authors.forename: Jean J
authors.initials: JJ
authors.lastname: de la Rosette
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D015607:Stents / Q000592:standards; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000592:standards; D064804:Urological Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014572:Urology / Q000592:standards*; D057832:Watchful Waiting / Q000592:standards*
chemical_list: D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D018727:Muscarinic Antagonists; D010726:Phosphodiesterase Inhibitors; D064804:Urological Agents