2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T68e,This Guideline covers the treatment of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The summary presented herein represents Part II of the three-part series dedicated to Management of LUTS attributed to BPH. Please refer to Parts I and III for additional information on this topic. The systematic review that informs this Guideline was based on searches in Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through January 2025. Update searches were conducted on December 15, 2025. Literature searches were limited to studies of medical therapies published since 2009 and surgical studies published since 2014. The searches were supplemented by reviewing electronic database reference lists of relevant articles. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest developed by the Panel. The medical management of LUTS/BPH is considered a part of non-procedural management, and the Guideline statements herein address this topic in addition to behavioral/lifestyle interventions for patients with LUTS/BPH. Specific risks are further elucidated for unique patient populations such as those undergoing ophthalmologic surgery. Non-procedural interventions should be provided within the shared decision-making context and take into account efficacy as well as durability and adverse events. It is also important to disclose unique actions of medication to relevant patient populations such as patients on active surveillance for prostate cancer.31:T80e,Benign prostatic hyperplasia (BPH) refers to the proliferation of glandular and stromal components within the transition zone of the prostate. Non-neurogenic lower urinary tract symptoms (LUTS) can be due to bladder, prostate, urethral, or other pathology. 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 escalation of treatment. This Guideline covers the evaluation and treatment of LUTS/BPH. The summary presented herein represents Part I of the three-part series dedicated to Management of LUTS/BPH. Please refer to Parts II and III and the full version of the Guideline for additional information on this topic. The systematic review that informs this Guideline was based on searches in Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through January 2025. Update searches were conducted on December 15, 2025. Literature searches were limited to studies of medical therapies published since 2009 and surgical studies published since 2014. The searches were supplemented by reviewing electronic database reference lists of relevant articles. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest developed by the Panel. The recommendations herein address initial presentation, evaluation, and initial management of patients with LUTS/BPH. Where possible, evidence levels were assigned along with relevant supporting text to assist clinicians when encountering men with LUTS/BPH. Standard evaluation is established with appropriate tests and shared decision-making. The presentation, evaluation, and initial management of patients presenting with LUTS/BPH is straightforward. In addition to patient history and physical examination, the recommendations herein include the appropriate use of tests and patient counseling.32:T55e,Benign prostatic hyperplasia (BPH) is one of the most prevalent urological disorders in ageing men. Medical therapies are widely used to treat BPH, but truly effective long-term treatments remain limited. Among the most commonly prescribed drugs are 5α-reductase inhibitors (5ARIs), which alleviate symptoms and slow disease progression by inhibiting steroid 5α-reductase (SRD5A) enzymes, particularly the SRD5A1 and SRD5A2 isoforms. SRD5A2, the dominant isoform in the prostate, has a pivotal role in androgen metabolism by converting testosterone into dihydrotestosterone, a potent driver of prostate growth. Proper regulation of SRD5A2 is essential to maintain the balance between androgenic and oestrogenic signalling, thereby supporting healthy prostate physiology. Emerging evidence links SRD5A2 alterations, such as genetic polymorphisms, epigenetic silencing and inflammation-induced changes to disease risk and progression, positioning these factors as promising biomarkers for personalized therapy. Beyond BPH, SRD5A2 has also been implicated as a potential therapeutic target in prostate cancer and androgenic alopecia. Thus, SRD5A2 has clinical relevance in BPH, prostate cancer and other androgen-mediated conditions. However, limitations of SRD5A2-targeted therapies need to be overcome for future strategies to enhance the efficacy of 5ARI-based treatments.33:T6ed,Society values a full head of hair. Therefore, androgenetic hair loss (AGA), though medically benign, can cause significant emotional distress. There is strong demand for alternative (nonconventional, over-the-counter) AGA treatments. It is important to have evidence on the efficacy of these treatments for AGA-especially in comparison with treatments that are approved by the United States Food and Drug Administration (FDA), such as oral finasteride and topical minoxidil. Following a systematic review, we conducted a network meta-analysis (NMA) to determine the relative efficacy of conventional monotherapies and selected alternative (nonconventional, over-the-counter) products for male AGA. We conducted a Bayesian NMA under a fixed effect model with uniform priors; the NMA estimated relative effects-as per mean difference (MD), along with the 95% credible interval (CI)-and surface under the cumulative ranking curve (SUCRA) values. We also assessed study-level evidence quality. Eligible studies were identified through systematic searches (without date restrictions) in PubMed and Scopus on April 30, 2025. The main outcome measure was change in total hair density at 24 weeks from baseline (in hairs/cm We found 24 eligible trials-where the relative efficacy of eight conventional monotherapies and seven alternative (nonconventional, over-the-counter) products was determined. The current NMA study confirms the efficacy of conventional monotherapies such as oral dutasteride, topical/oral minoxidil, and oral/topical finasteride for male AGA. We have provided guidance regarding the relative efficacy of some alternative (nonconventional, over-the-counter) agents (e.g., melatonin (topical) and rosemary oil (topical)) compared to conventional treatments.34:T866,ABSTRACTBackgroundSociety values a full head of hair. Therefore, androgenetic hair loss (AGA), though medically benign, can cause significant emotional distress. There is strong demand for alternative (nonconventional, over‐the‐counter) AGA treatments. It is important to have evidence on the efficacy of these treatments for AGA—especially in comparison with treatments that are approved by the United States Food and Drug Administration (FDA), such as oral finasteride and topical minoxidil.AimsFollowing a systematic review, we conducted a network meta‐analysis (NMA) to determine the relative efficacy of conventional monotherapies and selected alternative (nonconventional, over‐the‐counter) products for male AGA.MethodsWe conducted a Bayesian NMA under a fixed effect model with uniform priors; the NMA estimated relative effects—as per mean difference (MD), along with the 95% credible interval (CI)—and surface under the cumulative ranking curve (SUCRA) values. We also assessed study‐level evidence quality. Eligible studies were identified through systematic searches (without date restrictions) in PubMed and Scopus on April 30, 2025. The main outcome measure was change in total hair density at 24 weeks from baseline (in hairs/cm2).Results and ConclusionWe found 24 eligible trials—where the relative efficacy of eight conventional monotherapies and seven alternative (nonconventional, over‐the‐counter) products was determined. The current NMA study confirms the efficacy of conventional monotherapies such as oral dutasteride, topical/oral minoxidil, and oral/topical finasteride for male AGA. We have provided guidance regarding the relative efficacy of some alternative (nonconventional, over‐the‐counter) agents (e.g., melatonin (topical) and rosemary oil (topical)) compared to conventional treatments.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"5-Alpha Reductase Inhibitor: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on 5-Alpha Reductase Inhibitor (modality). Clinician-written summaries and actionable practice insights. 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The low rate of local irritation (7.3%) supports tolerability in routine practice."}},{"doi":"10.1097/ju.0000000000005091","pmid":"42143772","title":"Predictors of Medication Cessation After Benign Prostatic Hyperplasia Procedures","journal_title":"Journal of Urology","journal_issn":"0022-5347","published_at":"2026-05-17T00:00:00.000Z","url":"https://doi.org/10.1097/ju.0000000000005091","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-09T13:50:16.808Z","updated_at":"2026-06-09T13:50:16.808Z","tags":[{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"condition","value":"Benign Prostatic Hyperplasia","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"condition","value":"Overactive Bladder","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"5-Alpha Reductase Inhibitor","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Alpha Blocker","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Laser Enucleation of the Prostate","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Minimally Invasive Surgical Therapy","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Prostatic Urethral Lift","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Simple Prostatectomy","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Transurethral Surgery","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"modality","value":"Water Vapor Thermal Therapy","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"sample_size","value":"n=12633","value_numeric":12633},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"warning","value":"Claims data cannot confirm whether medication cessation reflects treatment success or non-adherence/loss to follow-up.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"warning","value":"Industry consultant relationships exist among several authors for devices used in the study (e.g., Boston Scientific, Karl Storz); funding from BCBSM may introduce payer-perspective bias.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"warning","value":"Specific BPH medication classes (e.g., alpha blockers vs. 5-ARIs) are not distinguished in the reported results; class-level cessation rates are unavailable from this abstract.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005091","tag_type":"warning","value":"The 'practice_changing' impact flag is applied because this is the first large real-world dataset providing procedure-specific medication cessation estimates for shared decision-making, though the retrospective design limits causal inference.","value_numeric":null}],"summaries":{"what_studied":"Using Michigan statewide insurance claims (2017–2022), this study evaluated rates and predictors of BPH and OAB medication cessation at 6–12 months after BPH surgery across three procedure categories: transurethral surgery (TURP, PVP, RWJT, LEP), MISTs (WVTT, PUL, PAE, TUMT), and simple prostatectomy (SP).","key_result":"Among 8,628 patients on pre-op BPH medications, 61% stopped by 1 year; among 933 on OAB medications, 62% stopped. Predicted BPH medication cessation was highest for LEP and SP (≥84%) and lowest for MISTs (<60%). No statistically significant difference in OAB medication cessation was found across procedure types. Older age, higher comorbidity burden, and anticoagulation use were associated with lower cessation rates.","limitations":"Claims data lack clinical detail (prostate size, symptom scores, urodynamics) and cannot distinguish patient- vs. provider-initiated cessation. Patients without continuous pharmacy enrollment were excluded, potentially limiting generalizability.","practice_takeaway":"When counseling patients who want to stop BPH medications, tissue-removing procedures (LEP, SP) offer the best chance—roughly 84% or better—while MISTs yield cessation in fewer than 6 of 10 patients. Set realistic expectations accordingly, especially for older patients with higher comorbidity burden."}},{"doi":"10.1097/ju.0000000000005098","pmid":"42095477","title":"Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part II: Medical Management","journal_title":"Journal of Urology","journal_issn":"0022-5347","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1097/ju.0000000000005098","source_score":23,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-12","doi":"10.1097/ju.0000000000005098","days":"7","issn":"0022-5347","rank":"4","field":"Clinical Medicine","score":"23","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & Nephrology"]},"pubmed":{"doi":"10.1097/JU.0000000000005098","title":"Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part II: Medical Management.","journal":"The Journal of urology","methods":"","results":"The medical management of LUTS/BPH is considered a part of non-procedural management, and the Guideline statements herein address this topic in addition to behavioral/lifestyle interventions for patients with LUTS/BPH. Specific risks are further elucidated for unique patient populations such as those undergoing ophthalmologic surgery.","abstract":"$30","keywords":["5-alpha reductase inhibitor","BPH","LUTS","acute urinary retention","alpha blocker","benign prostatic enlargement","benign prostatic hyperplasia","bladder outlet obstruction","ejaculatory dysfunction","erectile dysfunction","international prostate symptom score","intraoperative floppy iris syndrome","lower urinary tract symptoms","maximum urinary flow rate","overactive bladder","phosphodiesterase-type 5 inhibitor","post-finasteride syndrome","prostate-specific antigen","transurethral resection of the prostate"],"pubmed_id":"42095477","conclusions":"","publication_date":"2026-05-07T00:00:00"},"crossref":{"DOI":"10.1097/ju.0000000000005098","URL":"https://doi.org/10.1097/ju.0000000000005098","ISSN":["0022-5347","1527-3792"],"link":[{"URL":"http://www.auajournals.org/doi/pdf/10.1097/JU.0000000000005098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part II: Medical Management"],"author":[{"given":"Ramy","family":"Goueli","sequence":"first","affiliation":[{"name":"Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas"}]},{"given":"Gopal H.","family":"Badlani","sequence":"additional","affiliation":[{"name":"Department of Urology, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina"}]},{"given":"Charles","family":"Welliver","sequence":"additional","affiliation":[{"name":"Department of Urology, Albany Medical College, Albany, New York"}]},{"given":"Paul D.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Urology, Royal Melbourne Hospital, Victoria, Australia"}]},{"given":"Scott R.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of California San Francisco, San Francisco, California"},{"name":"San Francisco Veteran Affairs Healthcare System, San Francisco, California"}]},{"given":"Tracy","family":"Dana","sequence":"additional","affiliation":[{"name":"Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon"}]},{"given":"Rodrigo","family":"Donalisio da Silva","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Urology, University of Texas Houston McGovern Medical School, Houston, Texas"}]},{"given":"Rebecca","family":"Holmes","sequence":"additional","affiliation":[{"name":"Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon"}]},{"given":"Sennett K.","family":"Kim","sequence":"additional","affiliation":[{"name":"American Urological Association, Linthicum, Maryland"}]},{"given":"Erin","family":"Kirkby","sequence":"additional","affiliation":[{"name":"American Urological Association, Linthicum, Maryland"}]},{"given":"Steven","family":"Maislos","sequence":"additional","affiliation":[{"name":"Department of Urology, Urology Institute of Houston, Houston, Texas"}]},{"given":"Bradley C.","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Urology, Cleveland Clinic, Cleveland, Ohio"}]},{"given":"Timothy","family":"McClure","sequence":"additional","affiliation":[{"name":"Department of Urology and Radiology, Weill Cornell Medicine, New York, New York"}]},{"given":"Nicole L.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Urology, Vanderbilt Health, Nashville, Tennessee"}]},{"given":"Iraj","family":"Roshan","sequence":"additional","affiliation":[{"name":"Flint, Texas"}]},{"given":"Stephen J.","family":"Summers","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah"}]},{"given":"Annette","family":"Totten","sequence":"additional","affiliation":[{"name":"Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon"}]},{"given":"Jaspreet S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York"}]}],"issued":{"date-parts":[[2026,5,7]]},"member":"276","prefix":"10.1097","source":"Crossref","volume":null,"created":{"date-time":"2026-05-07T11:00:07Z","timestamp":1778151607000,"date-parts":[[2026,5,7]]},"indexed":{"date-time":"2026-05-07T11:15:02Z","timestamp":1778152502471,"date-parts":[[2026,5,7]]},"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"http://www.auajournals.org/doi/10.1097/JU.0000000000005098"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","order":0,"value":"2026-04-22"},{"name":"accepted","group":{"name":"publication_history","label":"Publication History"},"label":"Accepted","order":2,"value":"2026-04-23"},{"name":"published","group":{"name":"publication_history","label":"Publication History"},"label":"Published","order":3,"value":"2026-05-07"}],"deposited":{"date-time":"2026-05-07T11:00:08Z","timestamp":1778151608000,"date-parts":[[2026,5,7]]},"issn-type":[{"type":"print","value":"0022-5347"},{"type":"electronic","value":"1527-3792"}],"published":{"date-parts":[[2026,5,7]]},"publisher":"Ovid Technologies (Wolters Kluwer Health)","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1161/crossmarkpolicy","alternative-id":["10.1097/JU.0000000000005098"],"article-number":"10.1097/JU.0000000000005098","content-domain":{"domain":["www.auajournals.org"],"crossmark-restriction":true},"original-title":[],"container-title":["Journal of Urology"],"reference-count":0,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,7]]},"references-count":0,"short-container-title":["J Urol."],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1097/ju.0000000000005098","is_oa":false,"title":"Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part II: Medical Management","updated":"2026-05-08T16:02:47+00:00","published_date":"2026-05-07","best_oa_location":null}},"created_at":"2026-05-13T13:19:32.699Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"condition","value":"Benign Prostatic Hyperplasia","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"condition","value":"Lower Urinary Tract Symptoms","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"modality","value":"5-Alpha Reductase Inhibitor","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"modality","value":"Alpha Blocker","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"study_design","value":"Clinical Practice Guideline","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"warning","value":"Level of evidence set to '1' reflecting the systematic review basis of the guideline; individual statement levels may vary within the full document.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"warning","value":"No sample size is reported, as this is a systematic review–based guideline rather than a primary study.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"warning","value":"The 'practice_changing' impact flag is applied because this is an updated major society guideline (AUA 2026), not based on a single novel trial result.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005098","tag_type":"warning","value":"This is a guideline summary (Part II of III); specific drug recommendations, effect sizes, and grading of individual statements are not fully reported in the abstract — clinicians should consult the full guideline text for complete evidence tables.","value_numeric":null}],"summaries":{"what_studied":"This AUA Guideline (Part II of III) covers non-procedural (medical and behavioral/lifestyle) management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH), informed by a systematic review of literature through January 2025 (updated December 2025).","key_result":"The guideline provides evidence-based statements on medical therapies for LUTS/BPH, including shared decision-making, efficacy, durability, and adverse event profiles; it also highlights specific risks in unique populations (e.g., patients planning ophthalmologic surgery, those on active surveillance for prostate cancer).","limitations":"- Literature searches for medical therapies were limited to studies published since 2009, potentially excluding older relevant evidence.\n- The abstract does not report quantitative outcome data; specific drug-level efficacy figures are not available from this summary alone.\n- As a guideline document, it synthesizes existing evidence rather than generating new primary data.","practice_takeaway":"When managing LUTS/BPH medically, engage patients in shared decision-making that weighs efficacy, durability, and side effects — and always disclose medication-specific risks to high-risk subgroups (e.g., alpha-blocker–associated intraoperative floppy iris syndrome in patients scheduled for cataract surgery, and 5-ARI effects on PSA in men on prostate cancer active surveillance)."}},{"doi":"10.1097/ju.0000000000005097","pmid":"42095481","title":"Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part I: Presentation and Evaluation","journal_title":"Journal of Urology","journal_issn":"0022-5347","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1097/ju.0000000000005097","source_score":23,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-12","doi":"10.1097/ju.0000000000005097","days":"7","issn":"0022-5347","rank":"3","field":"Clinical Medicine","score":"23","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & 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Where possible, evidence levels were assigned along with relevant supporting text to assist clinicians when encountering men with LUTS/BPH. Standard evaluation is established with appropriate tests and shared decision-making.","abstract":"$31","keywords":["5-alpha reductase inhibitor","BPH","Erectile dysfunction","LUTS","alpha blocker, bladder outlet obstruction","benign prostatic enlargement","benign prostatic hyperplasia","international prostate symptom score","intraprostatic drug coated balloon","lower urinary tract symptoms","magnetic resonance imaging","maximum urinary flow rate","overactive bladder","prostate-specific antigen","recurrent urinary tract infection","robotic waterjet treatment","temporary implanted prostatic device","transrectal ultrasound","transurethral resection of the prostate","urodynamic studies","water vapor thermal 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Versus control, network estimates showed mean hair density gains at 24 weeks for minoxidil 5% topical: +20.0 hairs/cm² (95% CrI 3.7 to 41.0), dutasteride 0.5 mg oral: +19.0 (9.5 to 28.0), finasteride 0.25% topical: +15.0 (0.85 to 30.0), and finasteride 1 mg oral: +12.0 (4.20 to 19.0); OTC agents ranked mid to low (e.g., rosemary topical SUCRA 53.6%; melatonin topical 55.4%; saw palmetto topical 14.1%).","limitations":"Efficacy was assessed only at 24 weeks; baseline disease duration was not accounted for. Many alternative‑agent trials enrolled relatively small numbers, and several studies showed risk‑of‑bias concerns. Network geometry limited some node‑splitting inconsistency assessments.","practice_takeaway":"At 6 months, dutasteride 0.5 mg daily ranks highest for increasing hair density, with finasteride (oral/topical) and topical minoxidil also outperforming control by clinically meaningful margins. OTC options like topical rosemary and melatonin show modest relative efficacy, while saw palmetto ranks low—use these data to set expectations when discussing nonprescription alternatives."}}],"initialOffset":7,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"5-Alpha Reductase Inhibitor"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"5-Alpha Reductase Inhibitor"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"5-Alpha Reductase Inhibitor"}}}]]

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