Preservation of Sexual Function with the Prostatic Urethral Lift: A Novel Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Abstract

We investigated the prostatic urethral lift, a novel, minimally invasive treatment for symptomatic lower urinary tract complaints presumed to be from benign prostatic hyperplasia (BPH), which aims to mechanically open the prostatic urethra without ablation or resection. We hypothesized that this novel approach would not degrade erectile or ejaculatory function. We sought to determine the effect of the prostatic urethral lift procedure on erectile and ejaculatory function. The procedure was performed on 64 men in Australia with an average age of 66.9 years and an average duration of lower urinary tract symptom (LUTS) of 4.7 years. Primary inclusion criteria included International Prostate Symptom Score (IPSS) > 13, Qmax of 5-12 mL/second, and prostate specific antigen (PSA) < 10 ng/mL. Baseline IPSS was 22.9 ± 5.4 (N = 64). There were no inclusion criteria for sexual function. Baseline Sexual Health Inventory for Men (SHIM) was 11.7 ± 8.6 (N = 58); baseline Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) function score was 9.0 ± 3.7 (N = 46); and lack of sexual activity or unwillingness to answer sexual function questionnaires accounted for the reduced sample size in the sexual function instruments. Implants were placed to separate encroaching lateral prostatic lobes. Patients were evaluated at 6 weeks and 3, 6, and 12 months postprocedure via the SHIM and MSHQ-EjD instruments. There was no evidence of degradation in sexual function after treatment for LUTS with the prostatic urethral lift procedure. Erectile function, as measured by SHIM, was slightly increased at all time points as compared with baseline. No patient reported retrograde ejaculation at any follow-up visit. We demonstrated significant improvement in LUTS with no evidence of degradation in erectile or ejaculatory function after treatment with the prostatic urethral lift procedure. This procedure warrants further study as a new option for patients underserved by current treatments for LUTS/BPH.