Abstract
IntroductionSuccessful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies.Materials and methodsWe investigated the outcome of the PUL procedure at five German departments during the initial period when PUL was approved for the clinic (10/2012–06/2014). All candidates for transurethral resection of the prostate (TURP) received PUL information and were given the choice of procedures. The only exclusion criterion was an obstructive median lobe. No patients were excluded because of high post-void residual volume (PVR), prostate size, retention history or LUTS oral therapy. Maximum urinary flow (Qmax), PVR, International Prostate Symptom Score (IPSS) and Quality of Life (QOL) were assessed at baseline, 1, 6, 12, and 24 months after surgery.ResultsOf 212 TURP candidates, 86 choose PUL. A mean of 3.8 (2–7) UroLift implants were implanted in patients of 38–85 years with a prostate size of 17–111 ml over 57 (42–90) min under general or local anesthesia. Thirty-eight (38.4%) patients had severe BPH obstruction and would have been denied PUL utilizing previously reported study criteria. Within 1 month 74 (86%) reported substantial symptom relief with significant improvements in Qmax, PVR, IPSS, and QOL (p < 0.001) that was maintained within the follow-up. Sexual function including ejaculation was unchanged or improved. No Clavien–Dindo Grad ≥ 2 was reported postoperatively. Eleven (12.8%) patients were retreated over 2 years. Twelve (86%) of 14 patients presenting with chronic urinary retention were catheter free at last follow-up.ConclusionPUL is a promising surgical technique that may alleviate LUTS, even in patients with severe obstruction.
Highlights
Successful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations
We investigated the outcome of the newly approved PUL procedure in men treated for LUTS during the period from 10/2012 through 06/2014 at five German urology departments
In the German healthcare system, patients are commonly referred to urologic surgeons typically after failed attempts with pharmaceutical treatments and often with late stage urodynamic issues due to years of insufficient treatment of LUTS
Summary
Successful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Transurethral resection of the prostate (TURP) remains the primary treatment option with significant long-term improvement in clinical outcomes and low retreatment rates 10 years after intervention, attesting to its long-lasting effects [1, 2]. Reported perioperative and long-term complications include bleeding (requiring blood transfusions), acute urinary retention, clot retention, urinary tract infection, erectile dysfunction, retrograde ejaculation, bladder neck or urethral stricture [1, 2] Because of these complications, new therapeutic treatment options using innovative technologies to relieve patient symptoms are rapidly emerging [10,11,12,13]
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