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Gormley E.A.,American Urological Association Education and Research Inc. | Lightner D.J.,American Urological Association Education and Research Inc. | Faraday M.,American Urological Association Education and Research Inc. | Vasavada S.P.,American Urological Association Education and Research Inc.
Journal of Urology | Year: 2015

Purpose The purpose of this guideline amendment, herein referred to as the amendment, is to incorporate relevant newly published literature to better provide a clinical framework for the diagnosis and treatment of patients with non-neurogenic overactive bladder. Materials and Methods The primary source of evidence for this guideline is the systematic review and data extraction conducted as part of the Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Number 187 titled Treatment of Overactive Bladder in Women (2009). That report searched PubMed, MEDLINE®, EMBASE and CINAHL for English language studies published from January 1966 to October 2008. The AUA conducted additional literature searches to capture populations and treatments not covered in detail by the AHRQ report and relevant articles published through December 2011. The review yielded 151 treatment articles after application of inclusion/exclusion criteria. An additional systematic review conducted in February 2014 identified 72 additional articles relevant to treatment and made up the basis for the 2014 amendment. Results The amendment focused on four topic areas: mirabegron, peripheral tibial nerve stimulation, sacral neuromodulation and BTX-A. The additional literature provided the basis for an update of current guideline statements as well as the incorporation of new guideline statements related to the overall management of adults with OAB symptoms. Conclusions New evidence-based statements and expert opinion supplement the original guideline published in 2012, which provided guidance for the diagnosis and overall management of OAB in adults. An integrated presentation of the OAB guideline with the current amendments is available at www.auanet.org. © 2015 American Urological Association Education and Research, Inc. Source


Hanno P.M.,American Urological Association Education and Research Inc. | Erickson D.,American Urological Association Education and Research Inc. | Moldwin R.,American Urological Association Education and Research Inc. | Faraday M.M.,American Urological Association Education and Research Inc.
Journal of Urology | Year: 2015

Purpose The purpose of this amendment is to provide an updated clinical framework for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome based upon data received since the publication of original guideline in 2011. Materials and Methods A systematic literature review using the MEDLINE® database (search dates 1/1/83-7/22/09) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of IC/BPS. This initial review yielded an evidence base of 86 treatment articles after application of inclusion/exclusion criteria. The AUA update literature review process, in which an additional systematic review is conducted periodically to maintain guideline currency with newly published relevant literature, was conducted in July 2013. This review identified an additional 31 articles, which were added to the evidence base of this Guideline. Results Newly incorporated literature describing the treatment of IC/BPS was integrated into the Guideline with additional treatment information provided as Clinical Principles and Expert Opinions when insufficient evidence existed. The diagnostic portion of the Guideline remains unchanged from the original publication and is still based on Expert Opinions and Clinical Principles. Conclusions The management of IC/BPS continues to evolve as can be seen by an expanding literature on the topic. This document constitutes a clinical strategy and is not intended to be interpreted rigidly. The most effective approach for a particular patient is best determined by the individual clinician and patient. As the science relevant to IC/BPS evolves and improves, the strategies presented will require amendment to remain consistent with the highest standards of care. © 2015 American Urological Association Education and Research, Inc. Source


Cookson M.S.,American Urological Association Education and Research Inc. | Lowrance W.T.,American Urological Association Education and Research Inc. | Murad M.H.,American Urological Association Education and Research Inc. | Kibel A.S.,American Urological Association Education and Research Inc.
Journal of Urology | Year: 2015

Purpose The purpose of this amendment is to incorporate relevant newly-published literature to better provide a rational basis for the management of patients with castration-resistant prostate cancer. Materials and Methods The original systematic review and meta-analysis of the published literature yielded 303 articles published from 1996 through 2013. This review formed a majority of the guideline statements. Clinical Principles and Expert Opinions were used for guideline statements lacking sufficient evidence-based data. In April 2014, the CRPC guideline underwent amendment based on a second comprehensive literature search, which retrieved additional studies published between February 2013 and February 2014. Thirty-seven studies from this search provided data relevant to the specific treatment modalities for CRPC. Results Guideline statements based on six index patients developed to represent the most common scenarios encountered in clinical practice were amended appropriately. The additional literature provided the basis for an update of current supporting text as well as the incorporation of new guideline statements. Specifically, the addition of Radium-223 was placed in the guidelines related to the treatment of CRPC. Conclusions Given the rapidly evolving nature of this field, this guideline should be used in conjunction with recent systematic literature reviews and an understanding of the individual patient's treatment goals. Patients' preferences and personal goals should be considered when choosing management strategies. The newly incorporated evidence-based statements supplement the original guideline published in 2013, which provided guidance for the treatment of men with CRPC. This guideline will be continually updated as new literature emerges in the field. © 2015 American Urological Association Education and Research, Inc. Source


Lowrance W.T.,American Urological Association Education and Research Inc. | Roth B.J.,American Urological Association Education and Research Inc. | Kirkby E.,American Urological Association Education and Research Inc. | Murad M.H.,American Urological Association Education and Research Inc. | Cookson M.S.,American Urological Association Education and Research Inc.
Journal of Urology | Year: 2016

Purpose The purpose of this amendment is to incorporate relevant newly-published literature to better provide a rational basis for the management of patients with castration-resistant prostate cancer. Materials and Methods The original systematic review and meta-analysis of the published literature yielded 303 studies published from 1996 through 2013. This review informed the majority of the guideline statements. Clinical Principles and Expert Opinions were used for guideline statements lacking sufficient evidence. In April 2014, the CRPC guideline underwent amendment based on an additional literature search, which retrieved additional studies published between February 2013 and February 2014. Thirty-seven studies from this search provided data relevant to the specific treatment modalities for CRPC. In March 2015, the CRPC guideline underwent a second amendment, which incorporated 10 additional studies into the evidence base published through February 2015. Results Guideline statements based on six index patients developed to represent the most common scenarios encountered in clinical practice were amended appropriately. The additional literature provided the basis for an update of current supporting text as well as the incorporation of new guideline statements for multiple index patients. Conclusions Given the rapidly evolving nature of this field, this guideline should be used in conjunction with recent systematic literature reviews and an understanding of the individual patient's treatment goals. Patients' preferences and personal goals should be considered when choosing management strategies. This guideline will be continually updated as new literature emerges in the field. © 2016 American Urological Association Education and Research, Inc. Source


Greene K.L.,American Urological Association Education and Research Inc. | Albertsen P.C.,American Urological Association Education and Research Inc. | Babaian R.J.,American Urological Association Education and Research Inc. | Carter H.B.,American Urological Association Education and Research Inc. | And 7 more authors.
Journal of Urology | Year: 2013

Purpose: We provide current information on the use of PSA testing for the evaluation of men at risk for prostate cancer, and the risks and benefits of early detection. Materials and Methods: The report is a summary of the American Urological Association PSA Best Practice Policy 2009. The summary statement is based on a review of the current professional literature, clinical experience and the expert opinions of a multispecialty panel. It is intended to serve as a resource for physicians, other health care professionals, and patients. It does not establish a fixed set of guidelines, define the legal standard of care or pre-empt physician judgment in individual cases. Results: There are two notable differences in the current policy. First, the age for obtaining a baseline PSA has been lowered to 40 years. Secondly, the current policy no longer recommends a single, threshold value of PSA, which should prompt prostate biopsy. Rather, the decision to proceed to prostate biopsy should be based primarily on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities. Conclusions: Although recently published trials show different results regarding the impact of prostate cancer screening on mortality, both suggest that prostate cancer screening leads to overdetection and overtreatment of some patients. Therefore, men should be informed of the risks and benefits of prostate cancer screening before biopsy and the option of active surveillance in lieu of immediate treatment for certain men diagnosed with prostate cancer. © 2013 American Urological Association Education and Research, Inc. Source

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