In the prevention of benign prostatic hyperplasia, measures such as diet, cessation off alcohol, physical activity, positive environment and avoiding smoking, microbiome stabilization, sexual activity, bicycling can help in maintaining male health and loss of sexuality. Male lower urinary tract syndrome (LUTS) involves not only the prostate but is also associated with bladder symptoms, inflammation in the urinary tract, common intervention between pelvic organs and the rates of urine production by the kidney, psychological factors, frailty and underlying neurological disease. There have been several updations in guidelines over the years and the newer guidelines are now focussing on non-neurogenic male LUTS. Silodosin and Tadalafil is a combination widely discussed in guidelines but needs further validation. An Indian randomized controlled study on this combination demonstrated significant reduction in International Prostate Symptom Score (IPSS) at week 12 with similar results on Global IP assessment storage score and voiding sub score. With respect to safety, adding more drugs in the management of male LUTS often results in adding secondary effects. But, with Silodosin and Tadalafil combination there were more adverse events as compared to Tadalafil alone. The global overview on the interventional treatment had a global overview showed that besides the ablative surgical options of vaporisation and enucleation there are several competitors now available. These are aqua ablation, robotics and non-ablative options such as UroLIFT and Rezum. Stents and cages are the emerging options.

In male LUTS, it is yet unclear whether the minimally invasive options are a mandatory pathway before an invasive option. It is difficult to categorise whether behavioural therapy, medicines and minimal invasive or surgical processes as superior to one another. It has been shown that behavioural therapies can work as good as alpha blockers in lowering IPSS by 7 points. Transurethral resection of the prostate (TURP) is conducted at large in the United States with more minimally invasive surgeries. With respect to guidelines, they are more permissive due to the evidence available. During COVID pandemic in Europe, there was a reduction in surgeries for benign prostatic obstruction (BPO) surgeries. A report by Kaplan on Optilume in benign prostatic hyperplasia has demonstrated good results which were maintained upto 5 years. There was improvement in Qmax and IPSS. A matched pair analysis of Vapotherapy and TURP with Tetrafacta showed better results with Vapotherapy. On comparing Rezum with UroLIFT, show a faster recovery with UroLIFT.

European Association of Urology (EAU) Annual Congress 2024, 5th April - 8th April 2024, Paris, France