Prostatic Urethral Lift Research Articles

Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study.

There are growing interests for minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) uses selective angioembolization of prostatic arteries, thereby reducing size to improve LUTS/BPH. However, real-world data comparing surgical outcomes between MISTs and tissue resective techniques are lacking. We assessed the differences in surgical outcomes between PAE, transurethral resection of the prostate (TURP), and prostatic urethral lift (PUL) in a real-world population for LUTS/BPH. We present an observational population-based study of 12,902 men with BPH in New York State who received PAE, TURP, and PUL in outpatient and ambulatory surgery settings from 2014 to 2018. For short-term outcomes, we report 30-day and 90-day risks of readmission to inpatient and emergency room (ER) with/without complications and compared them across groups using χ2 tests and mixed-effect logistic regressions. For long-term outcomes, we report surgical retreatment and stricture rates using Kaplan-Meier failure curves and compared them using Log rank tests and Cox regression models. Of 12 902 men, 335 had PAE, 11,205 had TURP, and 1362 had PUL. PAE patients had the highest 30-day (19.9%) and 90-day (35.6%) risks of readmission to inpatient or ER (p < 0.01). Non-specific abdominal pain was the main diagnosis associated with 30-day and 90-day readmissions to inpatient or ER after PAE (14.3% and 26.8%, respectively). After 2years of follow-up, PAE patients had the highest retreatment rate of 28.5% (95%CI 23.7-34.2%) compared to TURP (3.4% (95%CI 3.1-3.8%)) and PUL (8.5% (95%CI 5.6-12.9%)) (p < 0.001). In a real-world population, PAE was associated with the most frequent 30-day and 90-day readmission to inpatient or ER and the highest retreatment rate among all surgical techniques even when controlled for individual patient comorbidities and surgical volume.

OP19 Comparative Effectiveness Of Common Treatment Options For Benign Prostatic Hyperplasia: A Systematic Review And Network Meta-Analysis

IntroductionTreatment options for men with moderate-to-severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) include medical therapy, minimally invasive surgical therapies (MISTs), and invasive surgical procedures. While these treatments are recommended by American Urological Association Guidelines, they have different clinical profiles impacting both efficacy and durability outcomes. Using an indirect comparison approach, this study assessed the clinical effects of combination therapy (CT) using alpha-blockers and 5-alpha reductase inhibitors, two emerging MISTs (prostatic urethral lift [PUL] and water vapor thermal therapy [WVTT]), and two invasive surgical procedures (photoselective vaporization of the prostate [PVP] and transurethral resection of the prostate [TURP]).MethodsA systematic search of Medline, Embase, Cochrane Library, and relevant health technology assessment (HTA) databases was conducted to identify randomized and non-randomized clinical trials of the five treatments published prior to December 2020. Trials were included if they reported changes in International Prostate Symptom Score (IPSS) and retreatment rates, without any country or language restrictions. A random-effects network meta-analysis (NMA) with an aggregate regression model was performed to account for the baseline BPH severity and characteristic differences among men from the different trials.ResultsA total of 237 of 3,104 retrieved abstracts were included for full-text review. Of these, 16 randomized and four non-randomized clinical trials were included in the NMA. The random-effects NMA showed among medical and minimally invasive therapies, WVTT had the greatest one-year IPSS improvement (-∆11.7), followed by PUL (-∆10.4) and CT (-∆10.3). The one-year IPSS improvement for TURP and PVP was comparable (-∆14.1 vs. -∆13.8, respectively; p-value=0.675). The one-year retreatment rates were lowest for WVTT (3.0%), followed by CT (3.6%), TURP (6.3%), PVP (7.8%), and PUL (8.0%).ConclusionsWVTT provided greater clinical and durability benefits compared to other less invasive treatment options for men with BPH. Given NMA is increasingly used in HTA processes, this study provided systematically synthesized evidence that could facilitate decision-makers in determining new technology coverage decisions globally.

A cost-effectiveness analysis of pharmacotherapy versus prostatic urethral lift as initial therapy for patients with moderate benign prostatic hyperplasia

ABSTRACT Aim The objective of this study was to evaluate the cost-effectiveness of an upfront minimally invasive surgical procedure, the prostatic urethral lift (PUL), as an initial treatment for patients with moderate benign prostatic hyperplasia (BPH), against current first-line pharmacotherapy with combination medical therapy. Method A micro-simulation model was developed using TreeAge Pro to compare two treatment strategies – initial treatment with combination medical therapy (alpha-blocker + 5-ARI) versus an upfront prostatic urethral lift procedure. The impact on disease progression, costs, and quality-adjusted life-years (QALYs) was analyzed. A Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the different strategies. The cost-effectiveness of the strategies at different willingness-to-pay (WTP) thresholds was then examined. Results Incremental costs (versus no prostatic urethral lift) were S$13,600 (1 year) and S$8,700 (5 years). Incremental QALYs were 0.07 (1 year) and 0.22 (5 years). An upfront PUL procedure was more expensive but also more effective than pharmacotherapy, with an incremental cost per QALY gain of approximately S$39,400. It is a cost-effective treatment option at the willingness-to-pay threshold of S$50,000. Conclusion Prostatic urethral lift is a cost-effective initial treatment option for men with moderate symptoms of benign prostatic hyperplasia.

Prostatic Urethral Lift for Obstructive Median Lobes: Consistent Results Across Controlled Trial and Real-World Settings.

Introduction: The evidence for prostatic urethral lift (PUL), in treating lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in men with obstructive median lobes (OMLs), has grown. In this study, we present the first detailed comparison of outcomes between OML patients treated with PUL in controlled and real-world settings to relevant comparators (subjects treated with transurethral resection of the prostate [TURP] and sham in randomized controlled trials [RCTs]) to demonstrate similar symptom, safety, and patient experience outcomes. Materials and Methods: Symptom and safety outcomes and patient satisfaction were compared through 12 months among controlled PUL studies: BPH6 RCT (35 men randomized to TURP); L.I.F.T. pivotal RCT in subjects with lateral lobe obstruction (66 subjects randomized to sham) and MedLift, an U.S. Food and Drug Administration-approved Investigational Device Exemption (IDE) extension of the L.I.F.T. trial (45 men with OML). Symptom improvement, catheterization, and adverse event rates were compared between MedLift subjects and OML patients (n = 187) from the large real-world retrospective (RWR) study of PUL filtered on baseline characteristics to approximate the MedLift population. Results: Posttreatment, International Prostate Symptoms Score (IPSS) improvement for MedLift subjects was 170% greater compared with sham at 3 months with significantly better quality of life (QoL), Qmax, and benign prostatic hyperplasia impact index (BPHII). Compared with TURP, MedLift IPSS and QoL improved significantly better at 1 and 3 months and with superior ejaculatory function scores at all time points after PUL. IPSS, QoL, postvoid residual (PVR), and Qmax outcomes were equivalent between MedLift and RWR OML groups at 3, 6, and 12 months. RWR OML patients did not experience higher rates of overall adverse events compared with MedLift. Conclusion: Controlled and real-world outcomes confirm PUL is a safe and effective treatment for BPH patients with and without OML.

Salvage versus primary holmium laser enucleation of the prostate: trends, outcomes and safety analysis.

To study the safety, efficacy and trends in index procedures leading to salvage holmium laser enucleation of the prostate (S-HoLEP). This was a single-institution retrospective review of HoLEPs performed between 2006 and 2020. Patients who underwent S-HoLEP were compared to those undergoing primary holmium laser enucleation of the prostate (P-HoLEP). The endpoint of primary interest were functional outcomes. Changes in index procedures over the study period were analyzed. A total of 633 HoLEPs were performed during the study, with 217 being S-HoLEP. The S-HoLEP cohort was older than P-HoLEP cohort, 71.2years vs 68.8years (p = 0.03). All other factors were well matched. The most common index procedures prior to S-HoLEP included transurethral resection of the prostate (TURP) (87, 40.1%), transurethral microwave thermotherapy (TUMT) (44, 20.3%), photoselective vaporization of the prostate (PVP) (24, 11.1%) and prostatic urethral lift (PUL) (24, 11.1%). Preoperative prostate volume, IPSS and Qmax were similar between groups. Intra-operatively, S-HoLEP had longer procedure and morcellation times (p = 0.01 and 0.007). Postoperatively, the S-HoLEP cohort had longer catheter duration and hospitalization (both p < 0.001). Postoperative Qmax, IPSS and 90-day complication rates were similar. On temporal analysis, minimally invasive surgical therapies (MIST) have become more prevalent as index procedures. S-HoLEP is safe and efficacious for patients requiring additional BPH surgical intervention. S-HoLEP patients had longer operative times and hospital stays but equivalent postoperative functional outcomes compared to P-HoLEP. As MIST mature and gain traction, it is expected that rates of S-HoLEP will continue to rise.

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update.

Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30–80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40258-022-00735-y.

EE257 Budget Consequences of Five Benign Prostatic Hyperplasia Treatment Options - US Medicare Perspective

Treatment options for men with moderate-to-severe lower urinary tract symptoms (LUTs) due to benign prostatic hyperplasia (BPH) lead to different healthcare costs. This study sought to determine the budget-impact of five treatment options including combination therapy (CT) of tamsulosin and dutasteride, water vapor thermal therapy (WVTT), prostatic urethral lift (PUL), photoselective vaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) for the treatment of BPH.

Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study.

Recently, minimally invasive therapies (MITs), such as water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL) have become an alternative to surgery or pharmacotherapy to manage benign prostatic hyperplasia (BPH), offering symptom relief with a favorable safety profile. The objective of this study was to evaluate the cost-utility of MITs (WVTT and PUL) compared to pharmacotherapy as initial treatment for patients with moderate-to-severe BPH. In this model-based economic evaluation we simulated BPH progression in men (mean age 65 years, average International Prostate Symptom Score 16.6) over their lifetime and estimated healthcare costs (from the US public payer perspective) per quality-adjusted life year (QALY), discounted at 3% annually. Various clinical scenarios were evaluated given that most men undergo several lifelong therapies up to surgical intervention and potentially thereafter. As such, in the study model men could receive up to three lines of therapy: (1) initial pharmacotherapy with MIT as second-line, and transurethral resection of the prostate (TURP) or pharmacotherapy as third-line; (2) initial MIT (WVTT or PUL) with MIT again, TURP or pharmacotherapy as second-line, and TURP as third-line. Model was populated using data from the published literature. Probabilistic analyses were performed. Initial treatment with WVTT led to the highest QALYs (13.05) and the lowest cost ($15,461). The cumulative QALYs and lifetime costs were 12.92 QALYs and $20,280 for pharmacotherapy followed by WVTT, 12.87 QALYs and $22,424 for pharmacotherapy followed by PUL, 12.86 QALYs and $20,930 for initial treatment with PUL. In the cost-utility analysis, WVTT as initial treatment dominated all three strategies, i.e., generated more QALYs at a lower cost. WVTT is an effective and cost-saving procedure, and may be an appropriate first-line alternative to pharmacotherapy for moderate-to-severe BPH patients who seek faster improvement and no lifelong commitment to daily medications.

3 - Prostatic urethral lift - A single center case series

3 - Prostatic urethral lift - A single center case series

Comparative efficacy and safety of prostatic urethral lift vs prostatic artery embolization for benign prostatic hyperplasia: a systematic review and network meta-analysis.

To assess and compare the clinical efficacy and safety of prostatic urethral lift (PUL) and prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) by means of a systematic review and network meta-analysis. A systematic literature search was performed using PubMed and Web of Science from inception to March 2021 to identify randomized controlled trials (RCTs) that compared PUL or PAE with either transurethral resection of the prostate (TURP) or sham procedures as control interventions. Qualitative and quantitative analyses were performed to pool the data on direct and indirect comparisons between interventions using STATA 14. Eight RCTs with 675 participants were included in our network meta-analysis. Quantitative synthesis revealed that TURP was the most efficacious intervention for clinical (International Prostate Symptoms Score and quality of life) and functional outcomes (maximum urinary flow rate and post-void residual urine volume), and was associated with a lower reintervention rate compared with PAE (risk ratio [RR] 2.08 with 95% confidence interval [CI] 0.96 to 4.51) and PUL (RR 2.33 with 95% CI 0.50 to 10.86), although the difference were not statistically significant. Indirect comparison indicated that PUL and PAE resulted in similar outcomes. PAE was associated with fewer minor adverse events (AEs; RR 0.75 with 95% CI 0.48 to 1.18) and PUL with fewer major AEs (RR 0.72 with 95% CI 0.17 to 3.13) when compared with TURP. Whilst PAE had a better ranking with regard to improvement of most clinical and functional outcomes, PUL was the best ranked procedure regarding erectile function, as measured by the International Index of Erectile Function 5, but no significant difference was observed. Current evidence suggests that PUL and PAE have similar clinical efficacy and safety profiles in the management of LUTS associated with BPH. However, the quality of evidence is relatively low because of the paucity of RCTs available, and results should be interpreted with caution.

MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL)

You have accessJournal of UrologyCME1 May 2022MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL) Samantha L. Thorogood, Tenny R. Zhang, Christina Sze, Gina DeMeo, Mary O. Strasser, Richard K. Lee, Bilal Chughtai, Alexis Te, and Jim C. Hu Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Tenny R. ZhangTenny R. Zhang More articles by this author , Christina SzeChristina Sze More articles by this author , Gina DeMeoGina DeMeo More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PUL vs. other benign prostatic hyperplasia (BPH) surgical approaches improves preservation of antegrade ejaculation and shortens both operative time and postoperative catheterization. We investigated trends associated with its use. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) case logs from 2015-2021. We identified 4,131 urologists who performed 48,610 surgeries with an indication for BPH per ICD coding. CPT codes distinguished BPH surgical approaches. We identified 786 urologists who performed 7,895 PUL: 24 urologists only performed PUL, and 3,345 urologists did not perform any PUL. A logistic regression model assessed factors independently associated with PUL use. RESULTS: Annual PUL surgeon volume ranged from 101 to 2,852 cases; PUL comprised 1.6% of BPH surgeries in 2015 and increased to 32.5% in 2020. In adjusted analyses (Table 1), factors associated with higher odds of performing PUL included subspecialization in andrology (odds ratio [OR] 4.01, 95% CI 1.94-8.29); practice area population >1,000,000 (OR 1.55, 95% CI 1.01-2.38); and government (OR 4.22, 95% CI 1.83-9.74), private practice group (OR 2.68, 95% CI 1.53-4.68), and salaried hospital employment (OR 1.94, 95% CI 1.00-3.96). The operative year (OR 1.66 per year, 95% CI 1.54-1.80) and surgeon BPH surgical volume (OR 1.02 per case increase, 95% CI 1.01-1.02) were associated with increased odds of performing PUL. Endourology subspecialization was associated with lower odds of PUL (OR 0.40, 95% CI 0.2-0.8). Geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age were not associated with PUL use. CONCLUSIONS: PUL utilization varies based on subspecialization, practice area, practice type, and BPH surgeon volume. Use of PUL has increased significantly and currently comprises one third of all BPH surgeries. More study is needed to determine durability of PUL outcomes particularly given its current widespread use and increasing adoption. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e3 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha L. Thorogood More articles by this author Tenny R. Zhang More articles by this author Christina Sze More articles by this author Gina DeMeo More articles by this author Mary O. Strasser More articles by this author Richard K. Lee More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP01-19 MINIMALLY INVASIVE AND ENDOSCOPIC THERAPIES FOR BENIGN PROSTATIC HYPERPLASIA: HEAD-TO-HEAD COMPARISON OF SHORT-TERM OUTCOMES BY NETWORK META-ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP01-19 MINIMALLY INVASIVE AND ENDOSCOPIC THERAPIES FOR BENIGN PROSTATIC HYPERPLASIA: HEAD-TO-HEAD COMPARISON OF SHORT-TERM OUTCOMES BY NETWORK META-ANALYSIS Linda Hamed, Jamaal Jackson, and Ephrem Olweny Linda HamedLinda Hamed More articles by this author , Jamaal JacksonJamaal Jackson More articles by this author , and Ephrem OlwenyEphrem Olweny More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical options for the management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) for prostates <80 g in size include endoscopic therapies i.e. mono- or bipolar transurethral resection of the prostate (mTURP, bTURP), vaporization or laser enucleation, as well as minimally invasive surgical therapies (MISTs) i.e. transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), prostatic urethral lift (PUL), water vapor thermotherapy (Rezum) and aquablation. We performed a head-to-head comparison of short-term outcomes for these treatment options by network meta-analysis. METHODS: A systematic review of randomized controlled trials from 1998 to 2018 in men with prostates <100 g, moderate-severe LUTS (International Prostate Symptom Score (IPSS) ≥ 8) and maximum urinary flow rates (Qmax) <15 mL/s, treated using any of the above modalities and reporting outcomes at a minimum follow up of 1 year was performed, including trials with a sham arm. Multivariable random effects network meta-analysis was used to compare the treatments with respect to IPSS, quality of life (QOL), Qmax and international index of erectile function (IIEF) scores at 1 year. For each outcome, treatments were ranked from best to worst using the surface under the cumulative ranking curve (SUCRA) method. Referent treatment was mTURP. RESULTS: A total of 26 studies met inclusion criteria. 1-year IPSS and QOL scores for each treatment modality were statistically similar to those for mTURP. Qmax for PUL, Rezum and TUNA were statistically lower than for mTURP, while flow rates for all other modalities were similar. 1-year IIEF scores were not available for aquablation, TUMT or TUNA, but scores for vaporization PUL and Rezum were notably higher than for mTURP, while those for enucleation and bTURP were similar. By SUCRA, the treatment with the highest probability of best urinary function was enucleation, while Rezum had the highest probability of sexual function. CONCLUSIONS: Compared with mTURP, Rezum and PUL achieved inferior flow rates but better IIEF scores, while vaporization achieved similar flow rates and higher IIEF scores. These findings could be invaluable in counseling patients on surgical outcomes for BPH. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e9 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Linda Hamed More articles by this author Jamaal Jackson More articles by this author Ephrem Olweny More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP33-13 IMPACT OF PROSTATIC URETHRAL LIFT DEVICE ON PROSTATE MR IMAGE QUALITY

You have accessJournal of UrologyCME1 May 2022MP33-13 IMPACT OF PROSTATIC URETHRAL LIFT DEVICE ON PROSTATE MR IMAGE QUALITY Tarik Benidir, Ryan Ward, Justin Ream, Ethan Austhof, Eric Klein, Ismail Turkbey, and Andrei Purysko Tarik BenidirTarik Benidir More articles by this author , Ryan WardRyan Ward More articles by this author , Justin ReamJustin Ream More articles by this author , Ethan AusthofEthan Austhof More articles by this author , Eric KleinEric Klein More articles by this author , Ismail TurkbeyIsmail Turkbey More articles by this author , and Andrei PuryskoAndrei Purysko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatic urethral lift (PUL) using the UroLift device is a non-pharmacological treatment option for patients with symptomatic benign prostatic hyperplasia. Patients with this device can safely undergo prostate MRI, but the influence of this device on prostate MR image quality has not been assessed. The aim of this study is to evaluate prostate MR image quality in patients with UroLift. METHODS: This retrospective study included 43 adult men (mean age 65.2yrs; mean PSA 5.86 ng/mL) with UroLift who underwent prostate MRI at two institutions. Images from one of the institutions (n=36) were reviewed and scored based on severity of artifacts caused by the device on T2-weighted (T2W), Diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) maps in the peripheral zone (PZ) and transition zone (TZ) using a 5-point scale (1 – no impact on interpretation; 5 – non-diagnostic). Total prostate gland volumes and the prostate volumes obscured by the artifacts on T2W, ADC maps and dynamic contrast enhanced (DCE) images were measured. The means of the scores assigned for severity of artifacts and percentage of gland volumes affected by the artifacts were calculated. T-test was used to compare differences in image quality scores. RESULTS: The average prostate volume was 59.1 cc (IQR: 42.7-79). The mean image quality scores were worse for DWI/ADC than T2W both in the PZ (1.7 vs 1, p=0.0001) and in the TZ (3.2 vs 1.7 p=0.001). Worse scores were observed on DWI/ADC in the TZ at the base and mid gland compared to the apex (means scores 3.8, 3.5 and 2.5, respectively; p <0.05). The mean prostate volumes obscured by artifact on T2W, ADC map and DCE were 3.3 cc (IQR:2.0-4.5), 16.2 cc (IQR:10.5-21.6) and 6.4 cc (IQR:3.4-7.3). The mean percentage of prostate volume obscured by artifacts on T2W, ADC map and DCE were 0.06 (95% CI 0.05 to 0.07), 0.3 (95% CI 0.25 to 0.35) and 0.11 (95% CI 0.08 to 0.14), respectively. CONCLUSIONS: UroLift causes artifacts that can affect prostate MRI interpretation, with greater impact in the TZ and on DWI/ADC maps (Figure 1). Men considering undergoing PUL procedure should be counseled on the negative impact of this device on quality of prostate MRI. Source of Funding: Cleveland Clinic imaging department © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e575 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarik Benidir More articles by this author Ryan Ward More articles by this author Justin Ream More articles by this author Ethan Austhof More articles by this author Eric Klein More articles by this author Ismail Turkbey More articles by this author Andrei Purysko More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA Tenny R. Zhang, Mary O. Strasser, Samantha L. Thorogood, Christina Sze, Bilal Chughtai, Alexis Te, Richard K. Lee, and Jim C. Hu Tenny R. ZhangTenny R. Zhang More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Christina SzeChristina Sze More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Compared to traditional treatment options for benign prostatic hyperplasia (BPH), holmium laser enucleation of the prostate (HoLEP) has demonstrated improved outcomes in hemostasis, urinary symptoms, and immediate complication rates. We investigated practice patterns associated with the use of HoLEP. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) certification/recertification case log data from 2008-2021. We identified 6,632 urologists who performed 73,884 surgeries with an indication for BPH. Current Procedural Terminology (CPT) codes distinguished HoLEP, transurethral resection of prostate (TURP), laser TURP, simple prostatectomy, prostatic urethral lift, transurethral incision of the prostate, and microwave and radiofrequency ablation. We identified 548 urologists (8.3%) who performed 7,386 HoLEP surgeries. Forty-three urologists (0.7%) performed HOLEP exclusively (no other BPH surgical approaches). A logistic regression model was used to determine factors independently associated with using HoLEP. RESULTS: The annual number of HoLEP procedures performed ranged from 3 to 1276, comprising 0.06% to 17.3% of total BPH surgeries annually. Highest HoLEP volumes were logged in 2019, representing 17.3% of total BPH cases. In adjusted analyses (table) factors associated with lower odds of performing HoLEP include surgeon age (odds ratio [OR] 0.93); government (OR 0.06), private practice group (OR 0.44), managed care (OR 0.14), salaried hospital (OR 0.38) vs. academic employment; and Mid-Atlantic (OR 0.28) and New England (0.45) regions vs. South Central (referent). Factors associated with higher odds of performing HoLEP include higher BPH surgical volume (OR 1.02) and endourology (OR 2.41) vs. general urology subspecialty. CONCLUSIONS: HoLEP is more likely to be performed by younger urologists, urologists in academic practice, endourology subspecialists, and those with higher BPH volume. HoLEP was less likely to be performed in Mid-Atlantic and New England regions. Additional studies are needed to elucidate practice pattern variations. Despite evidence demonstrating improved perioperative outcomes compared to competing BPH surgical approaches, HoLEP dissemination over time has been limited, possibly due to prolonged learning curve. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e60 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tenny R. Zhang More articles by this author Mary O. Strasser More articles by this author Samantha L. Thorogood More articles by this author Christina Sze More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Richard K. Lee More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

A comprehensive analysis of clinical, quality of life, and cost-effectiveness outcomes of key treatment options for benign prostatic hyperplasia.

Treatment options for men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) have variable efficacy, safety, and retreatment profiles, contributing to variations in patient quality of life and healthcare costs. This study examined the long-term cost-effectiveness of generic combination therapy (CT), prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), photoselective vaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) for the treatment of BPH. A systematic literature review was performed to identify clinical trials of CT, PUL, WVTT, PVP, and TURP that reported change in International Prostate Symptom Score (IPSS) for men with BPH and a prostate volume ≤80 cm3. A random-effects network meta-analysis was used to account for the differences in patient baseline clinical characteristics between trials. An Excel-based Markov model was developed with a cohort of males with a mean age of 63 and an average IPSS of 22 to assess the cost-effectiveness of these treatment options at 1 and 5 years from a US Medicare perspective. Procedural and adverse event (AE)-related costs were based on 2021 Medicare reimbursement rates. Total Medicare costs at 5 years were highest for PUL ($9,580), followed by generic CT ($8,223), TURP ($6,328), PVP ($6,152), and WVTT ($2,655). The total cost of PUL was driven by procedural ($7,258) and retreatment ($1,168) costs. At 5 years, CT and PUL were associated with fewer quality-adjusted life years (QALYs) than WVTT, PVP, and TURP. Compared to WVTT, the incremental cost-effectiveness ratios (ICERs) for both TURP and PVP were above a willingness-to-pay threshold of $50,000/QALY (TURP: $64,409/QALY; PVP: $87,483/QALY). This study provides long-term cost-effectiveness evidence for several common treatment options for men with BPH. WVTT is an effective and economically viable treatment in resource-constrained environments.

Factors that Drive Patient Satisfaction in Early Recovery Period After Minimally Invasive Surgical Therapy (MIST) for BPH: a Sub-Analysis of PUL and Rezum

ABSTRACT Introduction As utilization of MISTs for the treatment of BPH increases, physicians and patients should seek to understand not only long-term symptom outcomes, but also factors that may drive high satisfaction during the recovery period. Objective This new sub-analysis evaluates factors that may influence satisfaction in the early recovery period after undergoing Rezum Water Vapor Therapy (Rezum) or UroLift Prostatic Urethral Lift (PUL). Methods Within 2 months post-procedure, 30 PUL and 23 Rezum patients completed a questionnaire detailing their experience. Highly Satisfied patients achieved a pooled score of ≥3 on two questions on the subject of satisfaction (satisfaction with the effect of the procedure on urinary symptoms; satisfaction with speed and ease of recovery). For each question, a score of &amp;lt;0 = dissatisfaction and a score of +2 = high satisfaction. Outcomes were compared between all Highly Satisfied vs. all Dissatisfied patients, and between PUL vs. Rezum patients. Results Highly Satisfied patients in the early recovery period after either procedure reported significantly better absolute IPSS (8.0 vs. 24.3, p&amp;lt;0.0001) and QoL (1.0 vs. 4.6, p&amp;lt;0.0001) compared to Dissatisfied patients. Catheter duration was shorter for Highly Satisfied patients (1.9d) compared to Dissatisfied patients (5.6d, p=0.02). Highly Satisfied patients experienced lower rates of interference by their urinary symptoms with activities related to sports, entertainment, and community, and experienced less impact of recovery on work (p-value = 0.002). Within this early recovery timeframe, outcomes associated with increased satisfaction (IPSS, QoL, catheter duration, interference by urinary symptoms with sports, entertainment, and community activities) were better for PUL vs. Rezum patients (respective p-values: 0.001, 0.04, &amp;lt;0.001, 0.007, 0.01, 0.04). Conclusions Better absolute IPSS and QoL scores, less interference by urinary symptoms, and shorter duration of catheterization in the early recovery period appear to be factors which correspond to satisfaction in this population of MIST patients; these factors demonstrate superior outcomes for PUL patients compared to Rezum. Disclosure No

Management of New Complications from Prostatic Urethral Lift

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

Is Prostate Urethral Lift Effective in Patients with Multiple Comorbidities?

A prostatic urethral lift (PUL) can be performed under local anesthesia in patients normally at high risk for general anesthesia due to multiple comorbidities. However, the clinical efficacy of PULs in patients with multiple comorbidities remains unknown. Therefore, in this this study, we aimed to evaluate the clinical efficacy of the PUL in patients with a high number of comorbidities by comparing its clinical efficacy in these patients with that in healthy individuals. We performed a retrospective observational cohort study, in which patients who underwent a PUL between December 2016 and January 2019 at a single tertiary care center were categorized into two groups: healthy individuals who wanted to preserve sexual function (Group 1) and patients with a high number of comorbidities who were at high risk for general anesthesia, based on an American Society of Anesthesiologists (ASA) score of ≥3 (Group 2). The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were obtained preoperatively and compared throughout the 2-year follow-up. A total of 66 patients were enrolled, of whom 36 patients were included in Group 1 and 30 in Group 2. In Group 1, IPSS, IPSS quality of life (QoL), and Qmax significantly improved and were then maintained during follow-up, whereas, in Group 2, improvements in these parameters were not maintained during follow-up, except for IPSS QoL. Eleven patients (36%) in Group 2 required additional treatment for the recurrence of lower urinary tract symptoms. In conclusion, patients with a high number of comorbidities had a low therapeutic effect after PUL, suggesting a high rate of treatment failure. Therefore, comorbidity status should be considered when evaluating the potential benefits of the PUL procedure during preoperative counseling.

Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia.

To assess the differences in surgical outcomes between the prostatic urethral lift (PUL) and previous thermal energy procedures for the treatment of benign prostatic hyperplasia (BPH). We present an observational population-based study of 2694 men with BPH in New York State and California who received PUL, transurethral needle ablation (TUNA), or transurethral microwave therapy (TUMT) in outpatient and ambulatory surgery settings from 2005 to 2018. For these surgical procedures, short-term outcomes were reported and compared using a Chi-square test and mixed-effect logistic regressions. Long-term outcomes were described using Kaplan-Meier failure curves and compared using a Log-rank test and Cox regressions. A significant portion of PUL patients had a comorbidity count ≥ 2 (n = 838, 37.0%). PUL exhibited the lowest 30day and 90-day inpatient or ER readmission rates among all surgical techniques except for 90-day ER readmission (p < 0.05). No differences were observed for 1- and 3-year risks of reoperation between PUL [5.5% (95% CI 4.4-6.8%) and 14.9% (95% CI 10.9-20.1%)], TUNA [7.4% (95% CI 5.0-10.9%) and 11.3% (95% CI 8.3-15.4%)] and TUMT [8.5% (95% CI 4.7-15.2%) and 15.3% (95% CI 9.5-24.0%)]. 1- and 3-year risks of stricture development for PUL were 0.2% (95% CI 0.0-0.7%) and 0.2% (95% CI 0.0-0.07%), respectively. In a patient population with chronic conditions, patients treated with PUL exhibited similar 30- and 90-day inpatient or ER readmission rates when compared to previous reports. However, 1- and 3-year reoperation risks for PUL closely resembled previous thermal energy surgical procedures.

A0718 - Outcomes following the Prostatic Urethral Lift (PUL) are independent of prostate size and shape within real-world and controlled trial settings

A0718 - Outcomes following the Prostatic Urethral Lift (PUL) are independent of prostate size and shape within real-world and controlled trial settings