Management of New Complications from Prostatic Urethral Lift

Abstract

ABSTRACT Introduction Prostatic urethral lift (PUL) is a minimally invasive treatment for men with benign prostatic hypertrophy (BPH). This entails placing non-absorbable sutures with a nitinol prostate capsular anchor and a stainless-steel urethral end piece to mechanically open the intraurethral prostate for lower urinary tract symptoms (LUTS). There is a 12% incidence of complications from PUL. Here we present a single center experience with PUL along with management of the first known complication of PUL injuring the penile prosthesis reservoir and also a patient presenting with prostatic urethral adhesion following PUL. Objective To present the data of a single center experience with PUL and to document the first known injury of penile prosthesis reservoir from PUL and to discuss techniques and management of prostatic urethral adhesions from PUL. Methods A retrospective chart review was performed from the last two years of a single physician andrologic practice. Images and video was taken of the various rare complications encountered. Results A total of 63 PUL were performed. 1 patient had sepsis after the procedure. 2 patients had urinary retention that resolved after 7 days of catheterization. Ages ranged from 43-88 years, and prostate size ranges from 22- 90grams with a mean of 44 grams. IPSS score improved by 8 points. One patient was found to have a non-working penile implant 2 weeks after PUL. He underwent penile prosthesis revision and was found to have the PUL in the reservoir. 0 patients had retrograde or anejaculation after PUL. Three patients needed re-treatment after PUL, one opting for PUL the other opting for another modality. One patient who had PUL at another facility underwent intra-urethral prostatic stricture ligation for refractory (LUTS). Conclusions PUL is both safe and effective in the treatment of BPH. Caution should be taken in men with penile prosthesis and space of retzius reservoir placement as here we document the first PUL injury of the penile implant reservoir. Prostatic urethral stricture while rare can also occur and is best handled using an athermal technique to open the prostatic fossa. Disclosure No