Critical Review of Guidelines for BPH Diagnosis and Treatment Strategy

Abstract Objectives To provide a critical overview of the currently available guidelines on benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Methods Through a nonsystematic review of MEDLINE, we identified the guidelines produced by the following institutions: American Urological Association (AUA), Australian National Health and Medical Research Council (NHMRC), British Association of Urological Surgeons (BAUS), Canadian Urological Association, European Association of Urology (EAU), and the 5th International Consultation on BPH. All the guidelines were evaluated by the international appraisal instrument provided by the Appraisal of Guidelines, Research and Evaluation (AGREE) collaboration. Moreover, the recommendations concerning diagnosis and treatment from the different guidelines were compared. Results A wide discrepancy was observed among the overall quality of the guidelines. The guidelines from the Australian NHMRC and from the AUA yielded the highest overall scores, with 86 and 72 points, respectively. According to the domains of the AGREE appraisal instrument, the scores concerning "scope and purpose" and "clarity and presentation" were quite high and quite similar among the different documents, whereas the most relevant differences were observed in domains concerning the methodology of development of the guidelines. Conclusion Although all the texts had some good aspects, we found considerable differences in the overall quality of the available guidelines, especially with regard to the methodologic issues. The guidelines from the Australian NHMRC and AUA were most adherent to the standards of quality suggested by the AGREE appraisal instrument. In cases of controversial issues, clinicians could use the summarised data to select the guidelines they trusted the most to be used in their clinical practice.