2010 Update: Guidelines for the management of benign prostatic hyperplasia

Within the past decade, a number of significant advancements have occurred in our knowledge of benign prostatic hyperplasia (BPH) resulting in new approaches to both the diagnosis and treatment of this common and potentially progressive condition of aging men. The current document attempts to summarize the state-of-the-art knowledge regarding BPH and to highlight the essential diagnostic and therapeutic information in a Canadian context. The information included in this document was obtained from a MEDLINE search of the English language literature. Although references of historical importance are included, management recommendations are based on literature published between 2000 and 2009. These guidelines are directed toward the typical male patient over 50 years of age, presenting with lower urinary tract symptoms (LUTS) believed to be associated with benign prostatic obstruction (BPO). Men with LUTS associated with non-BPO causes will require more extensive diagnostic workup, different treatment considerations and their management will not be covered in this document. In this document we will address both diagnostic and treatment issues. Diagnostic guidelines are described in the following terms as: mandatory, recommended, optional or not recommended. Guidelines for treatment are described using the terminology: standard of care (evidence-based, whenever possible), optional (insufficient evidence or patient preference) or not recommended (based on the best available evidence). Whenever possible, levels of evidence and grades of recommendation will be provided to support guideline statements.