Transurethral Bipolar Plasmakinetic Prostatectomy Treatment For Benign Prostatic Hyperplasia In Chinese:Development Of A National Evidence-Based Clinical Practice Guideline(2018 Version)

Background Benign prostatic hyperplasia(BPH)is a common disease in aged males and its prevalence increases with age.Although the lower urinary tract symptoms caused by enlarged prostate gland brings nofatal threats,it prominently impairs patients' quality of life.Development and regular update of BPH-related clinical practice guidelines positively contribute to the promotion of standardized clinical and healthcare practice.According to results of evaluation concerning global BPH diagnosis and treatment guidelines,the transurethral resection of the prostate(TURP)is recommended by all guidelines.The transurethral bipolar plasmakinetic prostatectomy(TUPKP)is a new method and technique developed from TURP,aiming to overcome its disadvantages.TUPKP shows numerous strong points,and there is a trend that it may replace TURP's role as the gold standard for BPH.However,there is no clinical practice guideline on TUPKP treatment for BPH.Introduction To develop an evidence-based clinical practice guideline(E-CPG)on TUPKP treatment for BPH in Chinese population using the international standards and approach of E-CPG,in order to provide evidence for clinical practice.Methods This study was carried out according to the WHO handbook for guideline development.The Guideline Development Committee(GDC)identified the population,intervention,comparator,outcomes and time of interest(PICOt)questions after evaluation of all BPH guidelines worldwide;then the systematic reviews and meta-analyses were undertook for the major PICOt questions.The recommendations were formed according to a classification system of the European Association of Urology(EAU)Guidelines.All the recommendations were reviewed by the GDC using the Delphi conference and then revised before sent to the external review group.The Delphi conference was performed again after the external review.Results A total of 35 PICOt questions were primarily formed,and then revised to 28 questions after the first Delphi conference.These questions covered five domains:perioperative period of TUPKP,efficacy,safety,and economy of common volume BPH,large volume BPH,and special population BPH using TUPKP,and the follow-up and complications of TUPKP.The guideline presents clinical questions,followed by key recommendations and evidence review behind each recommendation.The majority of these 24 questions have practical considerations additionally.Conclusions Developing E-CPG is a complex process with considerable challenges.Challenges are mostly due to the fact that this is the first E-CPG in our urological field;hence,committee members need to be adapted to this develop approach and process,large volume of evidences synthesis,and low methodological quality of domestic clinical studies.Strict concordance with the WHO handbook for guideline development largely guaranteed transparency,as well as consideration of the interest of involved stakeholders,especially that of potential end-users.Lessons learnt during this guideline development process provide valuable knowledge for us and valuable insight for those planning development of E-CPG.