Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia
Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia
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DOI：
10.1016/j.juro.2011.01.074
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发表时间：
2011-05-01
影响因子：
6.6
通讯作者：
Wei, John T.
中科院分区：
文献类型：
--
作者：
McVary, Kevin T.;Roehrborn, Claus G.;Wei, John T.
目的：修订 2003 版美国泌尿外科协会 (AUA) 关于良性前列腺增生 (BPH) 治疗的指南。 材料和方法：使用相关 MeSH 术语从 MEDLINE (R) 检索英语出版物（1999 年 1 月至 2008 年 2 月），以及有关指标患者（一名年龄 >= 45 岁、正在就下尿路症状向医疗保健提供者咨询的男性）的管理的文章（LUTS）被识别。对证据进行了定性分析。选定的研究按设计、比较器、随访间隔和干预强度进行分层，并计划对随机对照试验的结果进行荟萃分析（定量综合）。指南声明由指定的专家小组根据证据起草。结果：研究在患者选择方面存在差异；随机化；致盲机制；磨合期；患者人口统计、合并症、前列腺特征和症状；药物剂量；其他干预特征；比较器；随访的严格性和间隔；试用期限和时间安排；怀疑缺乏对美国当前实践的适用性；和结果测量技术。这些变化影响了所审查证据的质量，使得正式的荟萃分析变得不切实际或徒劳。相反，专家小组和提取者以系统的方式审查了数据，但没有严格的统计。诊断和治疗流程取自2005年国际泌尿疾病咨询会议。关于药物治疗、观察等待、手术选择和微创手术的指南声明已更新或新起草，并经 AUA 董事会同行评审和批准。 结论：新的药物治疗和技术已经出现，影响了治疗算法。 LUTS/BPH 的管理不断发展。
Purpose: To revise the 2003 version of the American Urological Association's (AUA) Guideline on the management of benign prostatic hyperplasia (BPH).Materials and Methods: From MEDLINE (R) searches of English language publications (January 1999 through February 2008) using relevant MeSH terms, articles concerning the management of the index patient, a male >= 45 years of age who is consulting a healthcare provider for lower urinary tract symptoms (LUTS) were identified. Qualitative analysis of the evidence was performed. Selected studies were stratified by design, comparator, follow-up interval, and intensity of intervention, and meta-analyses (quantitative synthesis) of outcomes of randomized controlled trials were planned. Guideline statements were drafted by an appointed expert Panel based on the evidence.Results: The studies varied as to patient selection; randomization; blinding mechanism; run-in periods; patient demographics, comorbidities, prostate characteristics and symptoms; drug doses; other intervention characteristics; comparators; rigor and intervals of follow-up; trial duration and timing; suspected lack of applicability to current US practice; and techniques of outcomes measurement. These variations affected the quality of the evidence reviewed making formal meta-analysis impractical or futile. Instead, the Panel and extractors reviewed the data in a systematic fashion and without statistical rigor. Diagnosis and treatment algorithms were adopted from the 2005 International Consultation of Urologic Diseases. Guideline statements concerning pharmacotherapies, watchful waiting, surgical options and minimally invasive procedures were either updated or newly drafted, peer reviewed and approved by AUA Board of Directors.Conclusions: New pharmacotherapies and technologies have emerged which have impacted treatment algorithms. The management of LUTS/BPH continues to evolve.