Abstract
The Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Association of Urology (AFU) undertook an update of the French recommendations published in 2021, as well as those of the European Association of Urology (EAU) released in 2024, regarding the surgical and interventional management of bladder outlet obstruction (BOO) related to benign prostatic hyperplasia (BPH). A systematic review of the literature was conducted through PubMed® for the period 2023–2025, complementing the data already included in previous guidelines. This process was based on a predefined bibliographic strategy, followed by a critical analyze of the publications with assignment of levels of evidence, formulation of conclusions, and development of recommendations addressing specific clinical questions. Offer Bladder Neck Incision (BNI) for patients with moderate-to-severe LUTS and prostate volume < 30 cm 3 without a median lobe. Offer bipolar or monopolar transurethral resection of the prostate (TURP) for patients with moderate-to-severe LUTS and a prostate volume between 30 and 80 cm 3 . GreenLight™ or bipolar laser vaporization are alternatives to TURP, with GreenLight™ laser vaporization particularly suitable for patients at risk of bleeding. Offer endoscopic enucleation of the prostate as an alternative to TURP and open simple prostatectomy (OSP) for patients with moderate-to-severe LUTS. OSP may be offered for patients with moderate-to-severe LUTS and prostate volume > 80 cm 3 in centers without access to endoscopic enucleation. Minimally invasive simple prostatectomy is an alternative to OSP in centers lacking access to endoscopic enucleation techniques. Prostatic artery embolization (PAE) can be considered for patients with moderate-to-severe LUTS who desire a minimally invasive option and accept inferior outcomes compared with TURP, the indication should be confirmed by both a urologist and an interventional radiologist experienced in the procedure. Minimal volume for PAE is 40 cm 3 but has better efficacy for prostatic volume > 80 cm 3 . Prostatic artery embolization (PAE) may be offered to patients with moderate-to-severe LUTS who desire a minimally invasive option and accept inferior outcomes compared with TURP, the indication should be confirmed by both a urologist and an interventional radiologist experienced in the procedure. Minimal volume for PAE is 40 cm 3 but has better efficacy for prostatic volume > 80 cm 3 . Aquablation may be offered as an alternative to TURP for patients with moderate-to-severe LUTS and a prostate volume between 30 and 80 cm 3 . UroLift™ implants are an alternative for patients with moderate-to-severe LUTS desiring preservation of ejaculatory function and with prostate volumes < 80 mL without a median lobe. Rezūm™ may be offered as a surgical option for men with moderate-to-severe LUTS, desiring ejaculatory preservation, and with prostate volumes of 30–80 mL. Tind™ cannot currently be recommended for routine practice due to insufficient long-term data and lack of comparison with reference surgical techniques. Advances in surgical and interventional approaches to the management of BOO related to BPH are moving toward reducing treatment-related morbidity, while increasingly incorporating patients’ quality of life into therapeutic objectives, beyond the sole relief of LUTS.
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