Benign prostatic hyperplasia (BPH) refers to the proliferation of glandular and stromal components within the transition zone of the prostate and is largely a histologic diagnosis. Benign prostatic obstruction (BPO) refers to the obstruction of urine from the bladder by the prostate and can impact normal voiding and bladder function. Non-neurogenic lower urinary tract symptoms (LUTS) can be due to bladder, prostate, urethral, or other pathology, but the focus of this Guideline is on LUTS/BPH (LUTS attributed to BPH), which are multifactorial and can involve both the storage and emptying functions of the bladder. The lower urinary tract is vulnerable to bladder dysfunction, both over and under active, as well as to other systemic diseases and their treatments. These should be considered in the differential diagnosis and management of patients presenting with LUTS/BPH.  

Bothersome LUTS is the main reason patients seek treatment and generally drives management decisions. As such, shared decision-making plays a critical role in the initiation and subsequent escalation of treatment. Additionally, bladder function preservation should always be an important consideration in the management of LUTS/BPH.

There is a delicate interplay between medical and procedural therapies in the treatment of LUTS/BPH, with this Guideline hoping to provide a useful reference for an evidence-based approach to management of LUTS/BPH with discussion of the following:

• Initial and follow-up evaluation
• Non-procedural interventions
• Procedural therapies
• Special cases

Despite extensive research, there are still substantial gaps in knowledge, with multiple areas ripe for intervention and discovery. Areas for future growth discussed herein include incorporation of novel treatments; expanded use of advanced technologies; deeper understanding of disease etiology to improve patient stratification; and exploration of the influence of obesity, metabolic syndrome, and socioeconomic factors in the disease process and progression.