Management of Non-neurogenic Male LUTS

2. METHODS

2.1. Introduction

For the 2024 EAU Guidelines on Non-Neurogenic Male LUTS, incl. BPO, new and relevant evidence was 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 (SR) with meta-analysis, randomised controlled trials (RCTs), and prospective non-randomised comparative studies, published in the English language. Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1^st 2021 and May 1^st 2023. A total of 3,608 unique records were identified, retrieved and screened for relevance.

Detailed search strategies for the 2024 guideline are available online: http://www.uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/supplementary-material.

Recommendation within the Guidelines are developed by the panels to prioritise clinically important care decisions. 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 the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms which accompany each guideline statement, addresses a number of key elements:

1. the overall quality of the evidence which exists for the recommendation [1];
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 and certainty of patient values and preferences on the intervention.

Strong recommendations typically indicate a high degree of evidence quality and/or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence, and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [2].

Additional methodology information and a list of associations endorsing the EAU Guidelines can be found in the online: https://uroweb.org/eau-guidelines/methodology-policies.

2.2. Review

The Non-Neurogenic Male LUTS Guidelines were peer reviewed prior to publication in 2016. The newly added section on underactive bladder in males was peer reviewed prior to the publication in 2024.

2.3. Patients to whom the guidelines apply

Recommendations apply to men who seek professional help for LUTS in various non-neurogenic and non-malignant conditions such as BPO, detrusor overactivity (DO)/overactive bladder (OAB), urinary incontinence, and/or nocturnal polyuria. Specific context usually requires a more extensive work-up e.g., concomitant neurological diseases, young age, prior LUT disease or surgery, 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/.