Surgical and interventional management of bladder outlet obstruction related to benign prostatic hyperplasia: Systematic review of the literature and Clinical Practice Guidelines from the French Male LUTS Committee (CTMH)
Abstract
OBJECTIVE
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).
METHODS
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.
RESULTS AND RECOMMENDATIONS
Offer Bladder Neck Incision (BNI) for patients with moderate-to-severe LUTS and prostate volume 80cm3 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 40cm3 but has better efficacy for prostatic…
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