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

Prostate Cancer and Prostatic Diseases volume 27, pages 48–53 (2024)Cite this article

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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 EAU guidelines are a highly influential tool for the improvement and harmonization of clinical care. The guidelines must minimise bias whilst presenting a balanced view of risks and benefits, in which the preferences of patient, best clinical practice and highest quality evidence, is considered.

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Fig. 1
Fig. 2: Example of how the presentation of guideline recommendations has evolved.

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Author information

Authors and Affiliations

  1. Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus

    Stavros Gravas

  2. Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Sachin Malde

  3. Department of Urology, CHU Hôpitaux de Rouen-Hôpital Charles Nicolle, Rouen, France

    Jean-Nicolas Cornu

  4. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Mauro Gacci

  5. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Mauro Gacci

  6. Department of Urology, University Hospital Freiburg, Freiburg, Germany

    Christian Gratzke

  7. Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  8. Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece

    Markos Karavitakis & Charalampos Mamoulakis

  9. University of Basel, Basel, Switzerland

    Malte Rieken

  10. Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece

    Vasileios I. Sakalis

  11. European Association of Urology Guidelines Office, Arnhem, The Netherlands

    Natasha Schouten, Emma J. Smith & Karin Plass

  12. Department of Urology, Taunton & Somerset Hospital, Taunton, UK

    Mark J. Speakman

  13. Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Kari A. O. Tikkinen

  14. Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland

    Kari A. O. Tikkinen

  15. Department of Urology, Hygeia Hospital, Athens, Greece

    Gerasimos Alivizatos

  16. Department of Urology, Asklepios Westklinikum Hamburg, Hamburg, Germany

    Thorsten Bach

  17. Department of Urology, SwissUroCenter, Basel-Zurich, Basel, Switzerland

    Alexander Bachmann

  18. Department of Urology, Limoges University Hospital, Limoges, France

    Aurelian Descazeaud

  19. Hôpital Saint-Louis, Institut du Cancer AP-HP, Nord Université Paris Cité, Paris, France

    François Desgrandchamps

  20. Bristol Urological Institute, University of Bristol, Bristol, UK

    Marcus Drake

  21. UCL Division of Surgery & Interventional Science, University College London, and University College London Hospitals NHS Foundation Trust, London, UK

    Mark Emberton

  22. Department of Urology, General University Hospital of Patras, Patras, Greece

    Iason Kyriazis

  23. Department of Urology, Clinic Favoriten, Vienna, Austria

    Stephan Madersbacher

  24. Department of Pharmacology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany

    Martin C. Michel

  25. NHS Grampian, Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

    James N’Dow

  26. Center for Miniinvasive Techniques in Urology, Clinica S. Rita, Vercelli, Italy

    Massimo Perachino

  27. Hospital Royo Villanova, Zaragoza, Spain

    Carlos Rioja Sanz

  28. Department of Urology, Klinikum Sindelfingen-Bӧblingen, Sindelfingen, Germany

    Roland Umbach

  29. Deparment of Urology, Beacon Hospital, Dublin, Ireland

    Michel de Wildt

  30. Department of Urology, St. Antonius-Hospital, Gronau, Germany

    Matthias Oelke

  31. Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey

    Jean J. M. C. H. de la Rosette

Authors
  1. Stavros Gravas
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  2. Sachin Malde
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  3. Jean-Nicolas Cornu
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  4. Mauro Gacci
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  5. Christian Gratzke
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  6. Thomas R. W. Herrmann
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  7. Markos Karavitakis
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  8. Charalampos Mamoulakis
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  9. Malte Rieken
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  10. Vasileios I. Sakalis
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  11. Natasha Schouten
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  12. Emma J. Smith
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  13. Mark J. Speakman
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  14. Kari A. O. Tikkinen
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  15. Gerasimos Alivizatos
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  18. Aurelian Descazeaud
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  19. François Desgrandchamps
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  20. Marcus Drake
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  21. Mark Emberton
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  26. Massimo Perachino
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  28. Carlos Rioja Sanz
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  29. Roland Umbach
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  32. Jean J. M. C. H. de la Rosette
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Contributions

SG - conceptualisation, methodology, writing—review and editing, supervision. SM methodology, writing—original draft. JNC - methodology, writing—review and editing. MG - methodology, writing—review and editing. CG - methodology, writing—review and editing. TRWH - methodology, writing—review and editing. MK - methodology, writing—review and editing. CM - methodology, writing—review and editing. MR - methodology, writing—review and editing. VIS - methodology, writing—review and editing. NS - methodology, writing—review and editing. EJS - methodology, writing—review and editing. MJS - methodology, writing—review and editing. KAOT - methodology, writing—review and editing. GA - methodology, writing—review and editing. TB - methodology, writing—review and editing. AB - methodology, writing—review and editing. AD - methodology, writing—review and editing. FD - methodology, writing—review and editing. MD - methodology, writing—review and editing. ME - methodology, writing—review and editing. IK - methodology, writing—review and editing. SM - methodology, writing—review and editing. MCM - methodology, writing—review and editing. JND - methodology, writing—review and editing. MP - methodology, writing—review and editing. KP - methodology, writing—review and editing. CRS - methodology, writing—review and editing. RU - methodology, writing—review and editing. MDW - methodology, writing—review and editing. MO - methodology, writing—review and editing. JDLR - methodology, writing—review and editing.

Corresponding author

Correspondence to Stavros Gravas.

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Competing interests

ME: receives research support from the United Kingdom’s National Institute of Health Research (NIHR) UCLH/UCL Biomedical Research Centre and was appointed NIHR Senior Investigator in 2015. MO: consultant, speaker and/or trial participant for Apogepha, Astellas, Eli-Lilly, Ferring, GlaxoSmithKline, Pfizer, Pierre-Fabre, SAJA, Schwabe and SUN. MCM: consultancy and/or lecturer honoraria from Dr. Wilmar Schwabe, GSK, Stiftung Männergesundheit, Apogepha and Astellas. SG is a company consultant for Astellas and GSK; has received speaker honoraria from Astellas, Pierre Fabre and Ferring and has paid for access to the results of an independent study. J-NL Cornu is a Company consultant for Boston Scientific, Astellas, Medtronic, Mundipharma, STIMULI Technology (French); has received speaker honorarium from Astellas, Pierre Fabre Medicament, Recordati, Pfizer, Medtronic, Boston Scientific; has participated in clinical trials by Astellas, Coloplast, Allergan, IPSEN, Medtronic, IXALTIS, COUSIN Biotech, GT Urological; received fellowship and travel grants from Pierre Fabre Medicament, Recordati and received research support grants from Medtronic. CG is a company consultant for Astellas, GSK, Bayer, STEBA, MSD; received speaker honorarium from Astellas, Pfizer, Recordati, Bayer, IPSEN, Janssen and Amgen; received research grants from Recordati and participated in clinical trials by Astellas, NeoTract and MediTate. M. Gacci has received fellowship and travel grants from Lilly, Bayer, Pfizer, Ibsa, GSK, Astellas, Pierre Fabre, Konpharma, Recordati; has received speaker honorarium from GSK, Lilly, Recordati, Pierre Fabre, Ferring, Berlin-Chemie Menarini, Astellas, Teleflex Medical S.R.L. and participated in clinical trials by Lilly, Ibsa, Astellas, Institut de Recherche de Pierre Fabre. TH is a company consultant for Karl Storz SE & Co. KG Ass. CM participated in clinical trials for Ferring Pharmaceuticals and GlaxoSmithKline; received company speaker honorarium from Astellas and Ferring and received fellowship and travel grants from Astellas, Jansen and Olympus. MR is a company consultant for Boston Scientific, Lilly, Novartis, Astellas, Sanofi, Procept Biorobotics; has received speaker honorarium from Schwabe Pharma and fellowship and travel grants from the Swiss National Science Foundation, Pfizer, Abbvie, GSK and Amgen. MS is a company consultant for ISSECAM IVZW and a share holder in GlaxiSmithKline, Astra Zeneca and Pfizer. I. Kyriazis received Company speaker honorarium from Avatera Medical. SM received company speaker honorarium from Medtronic Ltd.

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Gravas, S., Malde, S., Cornu, JN. et al. From BPH to male LUTS: a 20-year journey of the EAU guidelines. Prostate Cancer Prostatic Dis 27, 48–53 (2024). https://doi.org/10.1038/s41391-023-00700-3

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