From BPH to male LUTS: a 20-year journey of the EAU guidelines

The European Association of Urology (EAU) aims to promote the highest standards of urological care throughout Europe. Fundamental to achieving this aim has been the development of evidence-based clinical practice guidelines. These guidelines are intended to improve quality of care, decrease variation in clinical practice and improve patient safety, as well as empowering patients to make informed health choices. Hence the guidelines may be instrumental in influencing healthcare policy [1]. These guidelines are widely perceived to be amongst the most important publications the EAU produce, and adherence to EAU guidelines has been shown to result in improved patient outcomes [2]. Previous studies have shown that adherence to guidelines for Benign Prostatic Hyperplasia (BPH) are poor, with less than 60% of men undergoing basic guideline-recommended investigations in one large study [3]. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions -also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care, although appropriate interpretation and application of guidelines is likely to lead to a safer medicolegal strategy than deviation from these evidence-based recommendations [4]. The first EAU Guideline on BPH was published in 2001 and over the years has been adapted considerably with regard to its concept and philosophy. It has changed from a guideline on BPH to non-neurogenic male lower urinary tract symptoms (LUTS), thereby highlighting the importance of looking beyond the prostate when trying to assess the underlying functional basis of a patient’s symptoms. Changes related to methodology and content have ensured that the breadth of conditions leading to male LUTS are included and that guideline recommendations are based upon the highest quality evidence, incorporating patients’ perspectives, values and preferences. This paper discusses these changes and highlights the e evolution of the guideline over the past 20 years (Fig. 1).