Guideline Video

Guideline Resources

  • Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia
  • American Urological Association
  • May 7, 2026
  • Summary
  • Full-text

Video Transcription

Just published May 7th, 2026, the American Urological Association’s newest guideline update on Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia.

This update provides an evidence-based approach to the evaluation and management of lower urinary tract symptoms associated with benign prostatic hyperplasia.

In today’s rapid update, we’ll just be going over a summary of key changes and recommendations that were added to this 2026 update. 

Let’s get started. 

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Starting with the section on Evaluation 

  • Clinicians may consider prostate-specific antigen (PSA) testing in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) following shared decision-making. 
  • Uroflowmetry and post-void residual (PVR) may be used in patients with LUTS/BPH to assess for urinary retention or rule out other conditions. 
  • Patients with LUTS/BPH should be counseled on risk factors for urinary retention and symptom progression, and BPH treatment may be considered in those with multiple non-modifiable risk factors.
  • Patients with LUTS/BPH should be re-evaluated within six months of treatment initiation, to assess response and treatment-related adverse effects.  
  • For patients with worsening LUTS/BPH, clinicians may consider non-invasive or invasive pressure flow testing/urodynamic studies (UDS) and/or cystoscopy. 
  • If symptoms do not improve after treatment, clinicians should consider alternative diagnosis and/or treatment approaches. 

Next the section on Non-Procedural Interventions

  • Behavioral and lifestyle interventions should be explored before or alongside pharmacologic treatment. 
  • For patients with LUTS/BPH, one of the following uroselective alpha blockers should be offered: silodosin, alfuzosin, or tamsulosin. 
  • Daily 5mg of tadalafil combined with a 5-alpha reductase inhibitor (5-ARI) may be considered for select patients with LUTS/BPH. 
  • Behavioral and lifestyle interventions should be considered for patients with LUTS/BPH with persistent LUTS despite medication treatment. 

Moving on to the section on Procedural Therapies

  • Patients considering procedural intervention should be counseled on progressive bladder functional changes, possible effects on sexual function, retreatment rates, and the need for re-evaluation.

And last the section on Procedural Technologies

  • Robotic waterjet treatment may be considered in patients with prostate between 80-150 cc.
  • Intraprostatic drug coated balloon may be considered in select patients for LUTS/BPH treatment. 
  • Prostate artery embolization (PAE) may be considered for select patients and should involve appropriate patient evaluation, trained PAE interventional radiologists,  and counseling regarding radiation. 
  • High-intensity focused ultrasound cavitation/ablation or cryoablation should not be routinely used outside clinical trial settings. 
  • Clinicians may offer temporary implantable prostate device, transurethral incision of the prostate, or transurethral resection of the bladder neck for patients with a suspected primary bladder neck obstruction.
  • Clinicians may offer holmium laser enucleation of the prostate, photoselective vaporization of the prostate, thulium laser enucleation of the prostate, or prostate artery embolization for patients at high risk of bleeding or requiring antiplatelet/anticoagulant therapy. 
  • Patients on active surveillance should be counseled that 5-ARI is not likely to increase prostate cancer progression risk. These patients may be offered procedural BPH treatment. 

And there you have it. Make sure to check out the full guideline from the American Urological Association and other related clinical decision support tools at guidelinecentral.com.

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