Non-interventional and medical management of lower urinary tract symptoms related to benign prostatic hyperplasia in men: Guidelines of the French LUTS Committee (CTMH).

OBJECTIVE

The male lower urinary tract symptoms (LUTS) panel of the French Urological Association (AFU) aimed to update the 2012 French guidelines for pharmacological treatment of LUTS secondary to benign prostatic hyperplasia (BPH).

METHODS

A systematic review of articles published between 2012 and 2024 was conducted in PubMed® to update the previous guidelines. The methodology included a predefined search strategy, critical appraisal of the literature with assignment of evidence levels, and the development of evidence-based conclusions and recommendations.

RESULTS/RECOMMENDATIONS: Monitoring may be offered to patients with mild to moderate LUTS who are not bothered by their symptoms. Men with LUTS should be offered lifestyle and dietary advice before or when initiating treatment. Alpha-blockers may be offered to patients with moderate to severe LUTS as first-line therapy. 5-alpha-reductase inhibitors (5-ARIs) may be offered to patients with moderate to severe LUTS and prostate volume above 40mL, though their therapeutic benefit requires sustained long-term administration. Combination therapy with alpha-blockers and 5-ARIs is indicated for moderate to severe LUTS when prostate volume exceeds 40mL. Serenoa repens in its hexanic extract formulation may be considered for mild to moderate LUTS. Antimuscarinics or beta-3 agonists may be offered to patients with moderate to severe LUTS and predominant storage symptoms as second-line therapy. Tadalafil alone or combined with alpha-blockers is recommended for moderate to severe LUTS, particularly when erectile dysfunction coexists.

CONCLUSION

These recommendations provide urologists with evidence-based guidance for more personalized management of BPH-related LUTS.