Concordance and gaps in the management of benign prostatic hyperplasia-associated male lower urinary tract symptoms: a structured comparison of the kazakhstan clinical protocol with the EAU and AUA 2026
Abstract
Benign prostatic hyperplasia (BPH), prostate enlargement, benign prostatic obstruction, and male lower urinary tract symptoms (LUTS) are related but nonequivalent concepts. This study compared the Kazakhstan clinical protocol for BPH with the 2026 guidelines of the European Association of Urology (EAU) and American Urological Association (AUA). A structured document analysis covered terminology, diagnostic assessment, conservative management, pharmacological treatment, surgery, and follow-up. Recommendations were classified as fully concordant, partially concordant, discordant, absent from the Kazakhstan protocol, or not directly comparable. Broad agreement was identified for symptom assessment, physical examination, urinalysis, selective prostate-specific antigen testing, α1-blockers, 5α- reductase inhibitors, tadalafil, combination therapy, conventional surgical indications, and transurethral resection of the prostate. Important gaps concerned symptom-centred terminology, shared decision-making, safety counselling, follow-up, and coverage of contemporary minimally invasive procedures. The publicly available Kazakhstan protocol also contained internally inconsistent medication doses requiring verification. Future revision should strengthen terminology, editorial control, patient-centred decision-making, and evidence-based assessment of modern procedures.
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