Prostatic Urethral Lift Research Articles

V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS Sean McAdams and Mitchell Humphreys Sean McAdamsSean McAdams More articles by this author and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video we demonstrate the feasibility of Holmium laser enucleation of the prostate (HoLEP) for retreatment of persistent lower urinary tract symptoms (LUTS) after previous treatment with the UroLift device. Technical considerations with regards to both enucleation and morcellation of resected tissue are discussed. Benign prostatic hyperplasia (BPH) affects millions of men worldwide. The UroLift system (NeoTract Inc., Pleasanton, CA) was recently introduced as a means to perform prostatic urethral lift (PUL) procedure for lateral lobe hypertrophy in patients with obstructive voiding symptoms. Urolift has been associated with a retreatment rate of 7% at 2 years and 14% at 4 years. Retreatment with TURP, photovaporization of the prostate and repeat UroLift has been described without notable issue, but retreatment with HoLEP has not yet been described. METHODS We included two patients who had undergone PUL with UroLift system at outside institutions and presented with recurrent LUTS. Patients were evaluated by cystoscopy, uroflowmetry, transrectal ultrasound of the prostate, and urodynamics to define the etiology of their urinary symptoms and determine appropriate therapy. HoLEP was performed under general anesthesia as previously described. Morcellation of the resected adenoma was performed with the VersaCut reciprocating morcellator (Lumenis Inc, Santa Clara, CA). RESULTS Enucleation was successfully completed in both patients. Monofilament sutures of the Urolift device were easily visualized and transected with the holmium laser. At the bladder neck, both patients were unexpectedly found to have the outer nitinol tab portions of UroLift devices located within the capsule of the prostate, rather than in the intended extracapsular location. Auxiliary maneuvers were required for removal of these nitinol tabs. The inner stainless steel portions of the UroLift device were encountered during morcellation of the resected adenoma. In each instance, the metal tabs became lodged in the reciprocating blades of the morcellator, requiring withdrawal of the morcellator instrument and manual removal of the tab from the morcellator blade. This resulted in brief disruptions in the procedure. There were no operative complications. CONCLUSIONS To our knowledge, we present the first description of HoLEP with morcellation of adenoma tissue after previous prostatic urethral lift surgery with the UroLift device. HoLEP can be performed safely and effectively post Urolift, however morcellation of the adenoma tissue is complicated by the metallic implants of the Urolift device. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e599 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sean McAdams More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP27-20 CONVECTIVE RADIOFREQUENCY WATER VAPOR ENERGY PROSTATE ABLATION (REZUM®) EFFECTIVELY TREATS URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-20 CONVECTIVE RADIOFREQUENCY WATER VAPOR ENERGY PROSTATE ABLATION (REZUM®) EFFECTIVELY TREATS URINARY RETENTION Nikhil Gupta, Bradley Holland, Kristin Delfino, Danuta Dynda, J. Randolf Beahrs, Lennart Wagrell, Ahmed El-Zawahry, Tobias Köhler, and Kevin McVary Nikhil GuptaNikhil Gupta More articles by this author , Bradley HollandBradley Holland More articles by this author , Kristin DelfinoKristin Delfino More articles by this author , Danuta DyndaDanuta Dynda More articles by this author , J. Randolf BeahrsJ. Randolf Beahrs More articles by this author , Lennart WagrellLennart Wagrell More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , Tobias KöhlerTobias Köhler More articles by this author , and Kevin McVaryKevin McVary More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.812AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES New minimally invasive surgical therapies (MIST) for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) such as prostatic urethral lift and convective radiofrequency water vapor energy prostate ablation (WaVE) have shown promising intermediate-term results in improving voiding symptoms. However, the initial trials excluded men in urinary retention; thus the ability of these new technologies to achieve catheter independence has not been evaluated. This study investigated outcomes of patients with urinary retention at baseline treated with WaVE. METHODS Patients in urinary retention who underwent WaVE were retrospectively identified. Urinary retention was defined as dependence on an indwelling catheter or performance of clean intermittent catheterization (CIC) for bladder emptying. Age, duration of catheter dependence, prostate size, baseline IPSS and PVR, and number of treatments per procedure were recorded. For subjects with successful trials without catheter (TWOC), time to catheter independence and post-procedure PVR and IPSS were recorded. Baseline characteristics between subjects with successful TWOC and unsuccessful TWOC were compared using Mann Whitney U test and T-test for continuous variables and Chi-square test and Fisher′s exact test for non-continuous variables. RESULTS 30 patients were identified with urinary retention who underwent WaVE. 22 subjects had an indwelling catheter, 8 subjects performed clean intermittent catheterization (CIC). Mean age was 76 years. Relevant baseline measures included (mean): duration of catheter dependence (6.9mo), prostate size (64.3 ml), PVR (538 mL), and number of treatments per procedure (6.4). 28/30 subjects had middle lobe treatment (1 treatment per procedure). 23 of 30 subjects (77%) achieved successful TWOC post-procedure. Mean time to catheter independence was 29 days post-procedure with mean post-procedure PVR 84 mL and post-procedure IPSS 9. There were no differences between subjects with or without successful TWOC in age, duration of catheter dependence, prostate size, baseline PVR, baseline IPSS, number of treatments per procedure, or treatment of median lobe. CONCLUSIONS WaVE can effectively treat patients with urinary retention and successfully render patients catheter independent, including patients with a median lobe. Longer-term follow up is necessary to evaluate the durability of this technology. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e337 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nikhil Gupta More articles by this author Bradley Holland More articles by this author Kristin Delfino More articles by this author Danuta Dynda More articles by this author J. Randolf Beahrs More articles by this author Lennart Wagrell More articles by this author Ahmed El-Zawahry More articles by this author Tobias Köhler More articles by this author Kevin McVary More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

192 - Long term (5 year) results from the largest, prospective, randomized, controlled study of the minimally invasive prostatic urethral lift (PUL)

192 - Long term (5 year) results from the largest, prospective, randomized, controlled study of the minimally invasive prostatic urethral lift (PUL)

Re: Prospective, Randomized, Multinational Study of Prostatic Urethral Lift versus Transurethral Resection of the Prostate: 12-Month Results from the BPH6 Study

Re: Prospective, Randomized, Multinational Study of Prostatic Urethral Lift versus Transurethral Resection of the Prostate: 12-Month Results from the BPH6 Study

Initial experience of prostatic urethral lift (UroLift); A minimally invasive treatment for symptomatic benign prostatic hyperplasia

Initial experience of prostatic urethral lift (UroLift); A minimally invasive treatment for symptomatic benign prostatic hyperplasia

24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham.

To evaluate the 24-month effectiveness of the prostatic urethral lift (PUL) procedure in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) assessed through a crossover study. In all, 53 patients underwent a sham procedure as part of the blinded, randomised L.I.F.T. (Luminal Improvement Following prostatic Tissue approximation for the treatment of LUTS secondary to BPH) study at 19 centres and elected to enrol in this crossover study. The crossover procedure involved placement of permanent implants (UroLift® system) into the prostatic lateral lobes. Patients were followed for 3months after the sham procedure and then for 24months after crossover to PUL, with assessments of urinary symptom relief, quality of life (QoL), urinary flow rate, sexual function, and adverse events. At 24months after crossover to PUL, the International Prostate Symptom Score (IPSS), QoL, BPH Impact Index, and maximum urinary flow rate improved 36%, 40%, 54%, and 77% from baseline, respectively. Each IPSS parameter on average improved significantly from baseline (P<0.005) and remained stable throughout follow-up. Symptom response after the sham procedure indicated initial improvement at 1month with significant decay by 3months. Adverse events were typically mild to moderate and patients returned rapidly to normal activity. Four patients (8%) required intervention with transurethral resection of the prostate and one patient required additional PUL implants within the 24-month period. There were no reported instances of de novo sustained erectile or ejaculatory dysfunction. The PUL procedure is associated with rapid symptom relief, increased urinary flow rate and QoL improvement that remain stable over 24months. Morbidity is low and sexual function is preserved.

New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review.

Life expectancy is constantly increasing and as a consequence older men, frequently with multiple comorbidities, are seeking treatment for benign prostatic hyperplasia. Given their frail health, these men need extreme attention in their management, as efficacious and safe treatment strategies in the general population may not be adequate for them. The National Library of Medicine Database was searched for relevant articles published between 2006 and 2015. Each article's title, abstract and text were reviewed for their appropriateness and their relevance. 57 articles were eligible for the review. In the elderly and frail, α1-antagonists should be used with caution given the risk of orthostatic hypotension and consequent falls, cause of significant morbidity in the elderly. 5ARIs present a good safety profile. Anticholinergics must also be prescribed with caution, given the risk of aggravating symptoms of dementia due to a central blockage of cholinergic neuronal pathways. Prostatic urethral lift is a medical device with low morbidity and valid functional results, which appear to endure over time. Prostatic artery embolization is demonstrating good results with minimal complication rates. Laser prostate vaporization or enucleation is also safe in elderly men and in those receiving anticoagulation therapy, due to its excellent hemostatic effect on prostatic tissue. Urologists should be familiar with the safety and efficacy profile of medical and surgical therapy in the elderly population, given the inevitable increase in older patients which we will observe in the near future.

The Prostatic Urethral Lift Method: A New Minimally Invasive Modality as an Alternative in the Treatment of Benign Prostatic Hyperplasia

The Prostatic Urethral Lift Method: A New Minimally Invasive Modality as an Alternative in the Treatment of Benign Prostatic Hyperplasia

Prostatic Urethral Lift: Worth the Hype?

Introduction The prostatic urethral lift (PUL) procedure is a minimally invasive, nonablative technique that opens the prostatic urethra via mechanical compression, without destruction or resection of prostatic tissue. We explore the safety, efficacy, and long-term durability of PUL and its ability to treat LUTS secondary to BPH. Furthermore, we will discuss the potential advantages and disadvantages of the procedure and how urologists can use this information when treating BPH. Lastly, we will critically evaluate how PUL can play a role in BPH management.

Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system.

The prostatic urethral lift procedure, more commonly known as UroLift, has been designed to improve male lower urinary tract symptoms while avoiding the complications and disadvantages of existing drug and surgical therapies. In particular, UroLift does not damage ejaculatory function or affect orgasmic sensation. It appears an option for men who wish to avoid long-term drug therapy, the side effects of drugs or surgery and who do not need or will not accept traditional surgical treatments. UroLift was introduced following a series of planned studies that led to US Food and Drug Administration approval in September 2013. UroLift has recently been approved by the UK National Institute for Clinical and Health Excellence (September 2015) as effective and safe and cost-effective for use in the UK health system. This review describes the device and the procedure and the evidence base that has led to those approvals.

Minimally Invasive Treatment for Male Lower Urinary Tract Symptoms: the Prostatic Urethral Lift

Male lower urinary tract symptoms (LUTS) are one of the most common non-malignant conditions afflicting quality of life in aging men. Treatment modalities for bothersome LUTS consist of pharmacotherapeutic and surgical options. There is particular interest in the development of minimally invasive procedures showing good efficacy with a favorable safety profile. An innovative technique offering rapid and durable relief without compromising sexual function is in great demand. The prostatic urethral lift represents a promising minimally invasive approach for the relief of bladder outlet obstruction (BOO) with few adverse events. The principle includes the application of retracting implants under cystoscopic guidance to unobstruct encroaching lateral lobes of the prostate. Clinical trials have confirmed improvement in LUTS with preservation of sexual function. The prostatic urethral lift appears to be a promising addition to the current repertoire of minimally invasive treatments for the management of LUTS.

PD21-02 PROSPECTIVE, RANDOMIZED, BLINDED STUDY OF PROSTATIC URETHRAL LIFT (PUL): FOUR YEAR RESULTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2016PD21-02 PROSPECTIVE, RANDOMIZED, BLINDED STUDY OF PROSTATIC URETHRAL LIFT (PUL): FOUR YEAR RESULTS Claus Roehrborn, Steven Gange, Neal Shore, Jonathan Giddens, Damien Bolton, Barrett Cowan, Anthony Cantwell, Kevin McVary, Peter Chin, Alexis Te, Shahram Gholami, Prem Rashid, William Moseley, Ronald Tutrone, Sheldon Freedman, Peter Incze, K. Scott Coffield, Fernando Borges, and Daniel Rukstalis Claus RoehrbornClaus Roehrborn More articles by this author , Steven GangeSteven Gange More articles by this author , Neal ShoreNeal Shore More articles by this author , Jonathan GiddensJonathan Giddens More articles by this author , Damien BoltonDamien Bolton More articles by this author , Barrett CowanBarrett Cowan More articles by this author , Anthony CantwellAnthony Cantwell More articles by this author , Kevin McVaryKevin McVary More articles by this author , Peter ChinPeter Chin More articles by this author , Alexis TeAlexis Te More articles by this author , Shahram GholamiShahram Gholami More articles by this author , Prem RashidPrem Rashid More articles by this author , William MoseleyWilliam Moseley More articles by this author , Ronald TutroneRonald Tutrone More articles by this author , Sheldon FreedmanSheldon Freedman More articles by this author , Peter InczePeter Incze More articles by this author , K. Scott CoffieldK. Scott Coffield More articles by this author , Fernando BorgesFernando Borges More articles by this author , and Daniel RukstalisDaniel Rukstalis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1469AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Prostatic Urethral Lift (PUL) procedure offers rapid, durable improvement in lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia with minimal adverse effects. PUL was assessed through a large, multi-center, randomized, blinded trial with 4 year follow up. METHODS 206 men with symptomatic LUTS secondary to benign prostatic hyperplasia (BPH) were randomized to PUL (N=140) or sham control (N=66) at 19 centers in North America and Australia. Enrollment criteria included age = 50 years, IPSS (International Prostate Symptom Score) = 13, peak flow (Qmax) = 12 ml/s, and prostate volume 30 - 80 cc. With endoscopic guidance, small, permanent metallic implants were transurethrally placed into the lateral lobes of the prostate. The lobes were held in a retracted, open position which reduced urinary obstruction. Through 3 month post index procedure, patients and assessors were kept blinded to treatment arm. PUL participants were assessed through 4 years via IPSS, quality of life (QOL), BPH Impact Index (BPH II), Qmax, Sexual Health Inventory for Men (SHIM), and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). RESULTS Average IPSS reduction was 44% by 1 month and 46% at 4 years (p value < 0.0001). Adverse events such as hematuria, dysuria, pelvic pain, urgency, and urge incontinence were typically mild and transient. There were no reported de novo, sustained erectile or ejaculatory adverse events. Sexual function assessments (SHIM, MSHQ-EjD) show stable erectile function average score and statistically improved average ejaculatory scores. For those subjects who have reached their 4 year follow up, 19 subjects have undergone repeat PUL or other procedure. CONCLUSIONS PUL patients suffer from little morbidity and on average achieve rapid, clinically meaningful LUTS relief. This preliminary data from the largest and longest study of the PUL procedure demonstrates that relief can be sustained to 4 years. In addition, sexual function is preserved, both in terms of erection and ejaculation. Durability will be assessed through protocol driven follow up through 5 years. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e456-e457 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Claus Roehrborn More articles by this author Steven Gange More articles by this author Neal Shore More articles by this author Jonathan Giddens More articles by this author Damien Bolton More articles by this author Barrett Cowan More articles by this author Anthony Cantwell More articles by this author Kevin McVary More articles by this author Peter Chin More articles by this author Alexis Te More articles by this author Shahram Gholami More articles by this author Prem Rashid More articles by this author William Moseley More articles by this author Ronald Tutrone More articles by this author Sheldon Freedman More articles by this author Peter Incze More articles by this author K. Scott Coffield More articles by this author Fernando Borges More articles by this author Daniel Rukstalis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urolift: a new chapter in benign prostate hyperplasia (BPH) therapy.

For over 30 years transurethral resection of the prostate (TURP) has held onto its crown as the gold standard surgical intervention for benign prostate hyperplasia (BPH), a disease process, which affects nearly 30 million men in Europe (1). However, minimally invasive alternatives such as Holmium laser enucleation of the prostate (HoLEP), thulium laser vapo-enucleation of the prostate (ThuVEP) and prostate artery embolization (PAE) have challenged the current status of this cornerstone treatment and re-shaped the surgical landscape accordingly (2-4). The urolift device (NeoTract Inc., Pleasanton, CA, USA), formally referred to as prostatic urethral lift (PUL), has attracted increased attention among the urological community and is the latest endoscopic method for BPH treatment (5). This novel technology deploys adjustable implants to establish a clear channel in the prostatic fossa via mechanical retraction of the lateral lobes. Potential advantages include a short learning curve and its use in the office setting as a day case procedure under local anaesthetic (LA). It is therefore an option for patients with multiple co-morbidities and patients at a higher risk of general or regional anaesthesia. Importantly, multiple clinical studies have reported no adverse sequelae on sexual function, which has an additional appeal for younger men. Although the long term efficacy of TURP is well recognised, it is associated with retrograde ejaculation in up to 75% of cases (6).

1076 Two year results of the BPH6 trial: A multi-center, prospective, randomized study of the prostatic urethral lift (PUL) vs transurethral resection of the prostate (TURP)

1076 Two year results of the BPH6 trial: A multi-center, prospective, randomized study of the prostatic urethral lift (PUL) vs transurethral resection of the prostate (TURP)

1077 Four year results from the largest, prospective, randomized study of prostatic urethral lift (PUL)

1077 Four year results from the largest, prospective, randomized study of prostatic urethral lift (PUL)

The Urolift System for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance.

As part of its Medical Technologies Evaluation Programme (MTEP), the National Institute for Health and Care Excellence (NICE) invited Neotract (manufacturer) to submit clinical and economic evidence for their prostatic urethral lift device, Urolift, for the relief of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS BPH). The Urolift System uses implants to retract the prostatic lobe away from the urethral lumen. The clinical evidence used in the manufacturer’s submission shows that Urolift is effective for the treatment of BPH. Urolift delivers a weighted mean International Prostate Symptom Score (IPSS) improvement of between 9.22 and 11.82 points. These Urolift improvements are greater than a published ‘marked improvement’ in IPSS score of 8.80. Comparison with randomised controlled trials (RCTs) of TURP (Transurethral Resection of Prostate) and HoLEP (Holmium Laser Enucleation of Prostate) show that Urolift does not yield better clinical outcomes from baseline compared to TURP and HoLEP in terms of IPSS, QoL (Quality of Life) and Qmax (maximum urinary flow). However, Urolift appears to have the advantage in terms of minimal and mild complications, and this may be of interest to patients and urologists. The economic case for Urolift was made using a very detailed and thorough de novo cost model. The base case posed by the manufacturer placed Urolift at almost cost-neutral (£3 cost incurring, based on 2014 prices) compared to TURP, and £418 cost incurring compared to HoLEP. In an additional scenario comparing day-case Urolift with in-patient TURP, the estimated per-patient savings with Urolift were £286 compared with monopolar TURP (mTURP) and £159 compared with bipolar TURP (BiTURP). NICE guidance MTG26 recommends that the case for adoption of Urolift was supported by the evidence, when implemented in a day-case setting.

Preservation of sexual function when relieving benign prostatic obstruction surgically: can a trade-off be considered?

There is increasing interest among men who require benign prostatic obstruction (BPO) surgery for treatment, which also preserves sexual function. Transurethral resection of the prostate (TURP) impacts sexual function; some novel treatments claim to preserve it. Concerns exist among urologists however: can sexual function truly be preserved whilst achieving the same magnitude and durability of lower urinary tract symptoms (LUTS) improvement? Can a trade-off be considered? This review examines the literature over the recent 12-18 months to determine whether surgical BPO treatments can truly preserve sexual function whilst effectively treating LUTS-BPO. TURP negatively impacts erectile function, but laser prostatectomy does not. Established cavitating BPO surgeries (TURP and laser prostatectomy) tend to have high rates of an ejaculation. Ejaculation sparing modifications to existing cavitating surgeries show promising outcomes in early reports. Prostatic urethral lift preserves ejaculatory and erectile function, whilst significantly improving LUTS in short to medium-term follow-up. WAVE (Rezum System) appears promising for LUTS treatment whilst preserving sexual function in early studies. Pathophysiological mechanisms underlying the association between LUTS-BPO and sexual function are not entirely understood. Whilst novel procedures can preserve both antegrade ejaculation and erectile function, long-term efficacy in maintaining benefits to LUTS is to be established. Although standard cavitating surgeries are associated with significant anejaculation, new modifications to surgical technique may offer promising solutions.

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Introduction: Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). The PUL procedure involves the placement of implants that retract the obstructing prostate lobes. This procedure achieves quantifiable improvements in functional outcomes and quality of life (QoL), while preserving erectile and ejaculatory functions. Methods: Seventeen patients diagnosed with BPH who had undergone the UroLift® procedure between March 2011 and June 2015 were retrospectively evaluated. The parameters evaluated in the pre-operative, intra-operative and 1-year post-operative period were demographic data, and pre-operative, intra-operative and 1-year post-operative results were obtained from the International Prostate Symptom Score (IPSS), Uroflowmetry QoL index, International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ) for ejaculatory function (MSHQ-EjD). Results: The average improvements from baseline to 12 months after intervention were significant for the total IPSS 9.6. There was a 4.2-point increase in Qmax, a 0.9-point improvement in QoL and a 32% decrease in PVR. No statistically significant difference was found in the IIEF and MSHQ-EjD scores when the pre-operative and post-operative 3rd and 12th month scores were evaluated (p > 0.05). Conclusions: PUL offers rapid improvement in voiding and storage symptoms, QoL and flow rate that is durable to 12 months after intervention. PUL is a minimally invasive procedure that has the moderate effect in treating troublesome LUTS secondary to benign prostatic obstruction and preserving total sexual function.

Minimally invasive devices for treating lower urinary tract symptoms in benign prostate hyperplasia: technology update.

Benign prostatic hyperplasia (BPH) represents a spectrum of related lower urinary tract symptoms (LUTS). The cost of currently recommended medications and the discontinuation rate due to side effects are significant drawbacks limiting their long-term use in clinical practice. Interventional procedures, considered as the definitive treatment for BPH, carry a significant risk of treatment-related complications in frail patients. These issues have contributed to the emergence of new approaches as alternative options to standard therapies. This paper reviews the recent literature regarding the experimental treatments under investigation and presents the currently available experimental devices and techniques used under local anesthesia for the treatment of LUTS/BPH in the vast majority of cases. Devices for delivery of thermal treatment (microwaves, radiofrequency, high-intensity focused ultrasound, and the Rezum system), mechanical devices (prostatic stent and urethral lift), fractionation of prostatic tissue (histotripsy and aquablation), prostate artery embolization, and intraprostatic drugs are discussed. Evidence for the safety, tolerability, and efficacy of these “minimally invasive procedures” is analyzed.

New intraprostatic injectables and prostatic urethral lift for male LUTS.

Treatment modalities for male lower urinary tract symptoms (LUTS) comprise a broad spectrum of medical and surgical options. Interest is growing in minimally invasive treatment options, which should ideally be performed in an outpatient setting and have a short recovery time, durable efficacy and a good safety profile. The preservation of all aspects of sexual function, including antegrade ejaculation, seems to be increasingly important for patients. Initial experimental data on new minimally invasive procedures-such as the intraprostatic injection of novel agents including botulinum neurotoxin A (BoNT-A), NX-1207 and PRX302-were promising, but clinical trials have not confirmed the findings. Trials of the mechanical prostatic urethral lift device-Urolift(®) (Neotract, Inc., USA)-have been positive, but further long-term results are needed to confirm its beneficial effects.