Prostatic Urethral Lift Research Articles

Meta-analysis and systematic review of intermediate-term follow-up of prostatic urethral lift for benign prostatic hyperplasia.

Prostatic urethral lift (PUL), is a relatively new minimally invasive procedure for treatment of benign prostatic hyperplasia (BPH).This article is a systematic review and meta-analysis of all the articles published including follow-up of at least 24months to analyze sustainability of results. We performed a critical review in according to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. From a total 768 published articles that matched our search terms, 5 studies with minimum follow-up of 24months were selected for comparison and data analyzed in terms of baseline characteristics, functional, and sexual health outcomes. Included in the analyses are five studies with a minimum follow-up of 24months. A total of 386 patients underwent PUL and 322 patients (83.4%) are available for follow-up at 24months. The randomized studies are grouped as group A and non-randomized studies as group B. At 24months, the mean reduction in International Prostate Symptom Score (IPSS) from baseline was 9.1 in group A and 10.4 in group B. The mean improvement in peak flow rate (Qmax) was 3.7mL/s in group A and 3mL/s in group B, and quality of life (QoL) improved by 2.2 in both groups. PUL is a well-tolerated, minimally invasive therapy for BPH that provides favorable and durable symptomatic, sexual health, and functional outcomes up to 24months. Longer follow-up and randomized studies comparing to current standards are required to further confirm the long-term sustainability of PUL.

327 Symptom Relief and Sexual Function Improvement for Patients with All Types of Prostate Enlargement after Prostatic Urethral Lift (PUL)

327 Symptom Relief and Sexual Function Improvement for Patients with All Types of Prostate Enlargement after Prostatic Urethral Lift (PUL)

331 Clinical Outcomes of Prostatic Urethral Lift in Men With Enlarged Median Lobes Compared With Results From The L.I.F.T. Study

331 Clinical Outcomes of Prostatic Urethral Lift in Men With Enlarged Median Lobes Compared With Results From The L.I.F.T. Study

Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia: A Cochrane review summary

Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia: A Cochrane review summary

EDITORIAL COMMENT

How important really is it for a man to preserve his antegrade ejaculation following a benign prostatic hyperplasia (BPH) procedure? How many men really care? These are 2 questions that have yet to be published on in our urologic peer reviewed literature. Prior to the advent of medical management for BPH this was a nonissue. The only treatments were open simple prostatectomy or transurethral resection of the prostate (TURP), both of which produced a very high rates of ejaculatory dysfunction and was just expected to occur for patients postprocedure. Once medical management became available, the preservation of ejaculatory function was significantly improved for BPH treatments, but some drugs still had a 30% dysfunction rate. 1 Kaplan S. Side effects of alpha-blocker use: retrograde ejaculation. Rev Urol. 2009; 11: 14-18 PubMed Google Scholar In the recent past, newer minimally invasive treatments have been developed which attempt to limit this dysfunction. The Rezum, Urolift, and Aquaablation systems all have published articles in our urologic peer reviewed literature that have very low rates of ejaculatory dysfunction. 2 McVary KT Gange SN Gittelman MC et al. Erectile and Ejaculatory Function Preserved with Convective Water Vapor Energy. Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. J Sex Med. 2016; 13: 924-933 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 3 McVary KT Gange SN Shore ND et al. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med. 2014; 11: 279-287 Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar , 4 Gilling P Kaplan Steven A. Gul Zeynup Te Alexis E. et al. Two-year outcomes after aquablation compared to TURP: efficacy and ejaculatory improvement sustained. Adv Ther. 2019; 36 (Jun): 1326-1336 Google Scholar

Prostatic Artery Embolization and the Median Lobe: Stuck in the Middle with You?

We read with great interest the study by Yu et al. ( 1 Yu S.C.H. Cho C.C.M. Hung E.H.Y. et al. Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol. 2019; 30: 1807-1816 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar ) that provides in-depth knowledge on the implications of the median lobe for patients with benign prostatic hyperplasia (BPH) treated with prostatic artery embolization (PAE). Frequently, physicians and patients ask if the median lobe is a contraindication for PAE in patients with BPH and if results are worse in these patients. The present study sheds some lights on this specific topic, proving that not all median lobes are the same, but many questions arise. What is the median lobe? What type of imaging classification can we use to assess it? What is the impact of the median lobe on the natural progression of disease in patients with BPH? Does the median lobe also limit the efficacy of other minimally invasive surgical techniques such as prostatic urethral lift (PUL) or water vapor thermal therapy? What do we know already about the effect of PAE for the median lobe? Can we target the median lobe during PAE? Is PAE effective when treating patients with BPH and a median lobe? Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic HyperplasiaJournal of Vascular and Interventional RadiologyVol. 30Issue 11PreviewTo evaluate the presence of intravesical prostatic protrusion (IPP) and its thickness-to-height (T/H) ratio as a predictor for the clinical outcome and morbidity of prostatic artery embolization (PAE) for benign prostatic hyperplasia. Full-Text PDF

Epidemiology and treatment modalities for the management of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting men. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms (LUTS). Over the last decade, increased modifiable risk factors, such as metabolic disease and obesity, have resulted in an increased incidence of BPH. This increasing incidence has brought about a multitude of treatment modalities in the last two decades. With so many treatment modalities available, physicians are tasked with selecting the optimal therapy for their patients. Current therapies can first be divided into medical or surgical intervention. Medical therapy for BPH includes 5-alpha-reductase inhibitors and alpha-blockers, or a combination of both. Surgical interventions include a conventional transurethral resection of the prostate (TURP), as well as newer modalities such as bipolar TURP, holmium laser enucleation of the prostate (HoLEP), Greenlight and thulium laser, and prostatic urethral lift (PUL). Emerging therapies in this field must also be further investigated for safety and efficacy. This narrative review attempts to consolidate current and emerging treatment options for BPH and highlights the need for additional investigation on optimizing treatment selection.

Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2020

The AUA Guideline panel provides evidence-based recommendations for the surgical management of male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The Panel amended the Guideline in 2020 to reflect additional literature published through September 2019. When sufficient evidence existed, the Panel assigned the body of evidence a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, the Panel provided additional information as Clinical Principles and Expert Opinions (See table 1[Table: see text]). Amendments to these Guidelines include: 1) an amended statement (Guideline 1) to include conducting a physical examination; 2) a new statement (Guideline 6) discussing concepts of treatment failure and retreatment; 3) an amended statement (Guideline 15) with updated supporting text for prostatic urethral lift (PUL); 4) an amended statement (Guideline 16) for PUL; 5) an amended statement (Guideline 17) with updated supporting text for transurethral microwave therapy (TUMT); 6) an amended statement (Guideline 18) with updated supporting text for water vapor thermal therapy; 7) updated supporting text for water vapor thermal therapy (Guideline 19); 8) an amended statement (Guideline 21) with updated supporting text for laser enucleation; 9) an amended statement (Guideline 22) with updated supporting text for Aquablation; and 10) an amended statement (Guideline 23) with updated supporting text for Prostate Artery Embolization (PAE). These evidence-based updates to the AUA Guidelines further inform the surgical management of LUTS/BPH.

Evaluation of Clinical Outcomes of Prostatic Urethral Lift for Benign Prostatic Hyperplasia: An Asian Population Study.

PurposeThis study aimed to assess the clinical outcomes of prostatic urethral lift in Korean patients with bothersome lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).Materials and MethodsThirty-two men with symptomatic BPH were consecutively treated in a tertiary care center in Korea. To be included in the present analysis, patients had to meet the following criteria: age ≥50 years, International Prostatic Symptom Score (IPSS) >12, and prostate volume between 30 mL and 80 mL. Patients were evaluated up to a median follow-up period of 1 year post-procedure. The primary outcomes included symptom relief, improvement of quality of life (QOL), and preservation of sexual function.ResultsAll procedures were finished with a mean of 2.2 implants without any serious complication. The numbers of patients diagnosed with diabetes mellitus, hypertension, and ischemic heart disease were 16 (50.0%), 24 (75.0%), and 9 (28.1%), respectively. Patients experienced symptom relief by 1 week that was sustained for 12 months. The mean IPSS, QOL, and maximum flow rate improved to 43%, 70%, and 25% by 1 week, and to 41%, 60%, and 32% by 12 months (p<0.001), respectively. There were no occurrences of early urge incontinence, retrograde ejaculation, or erectile dysfunction. Patient-reported adverse events were mild and transient.ConclusionsProstatic urethral lift is a safe and effective treatment for BPH in the Asian population. This treatment is minimally invasive, can be performed under local anesthesia, and may be an appropriate method for fragile patients.

Real-World Evidence of Prostatic Urethral Lift Confirms Pivotal Clinical Study Results: 2-Year Outcomes of a Retrospective Multicenter Study.

Introduction: This study expands results from recent prostatic urethral lift (PUL) clinical trials by examining outcomes within a large unconstrained multicenter data set.Methods: Retrospective chart review and analysis of 1413 consecutive patients who received PUL in North America and Australia was performed. International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) were evaluated at 1, 3, 6, 12, and 24 months post-procedure for all nonurinary retention subjects (Group A) and retention subjects (Group B). Within Group A outcomes were further analyzed using paired t-tests and 95% mean confidence intervals under the following parameters: IPSS baseline ≥13, age, prostate size, site of service, prostate cancer treatment, and diabetic status. Adverse events, surgical interventions, and catheterization rates were summarized in detail.Results: Compared with the randomized controlled prosatic urethral lift (L.I.F.T.) study, subjects in this retrospective study were older and less symptomatic. After PUL, mean IPSS for Group A improved significantly from baseline by at least 8.1 points throughout follow-up. No significant differences were observed between Group A and B follow-up symptom scores. Within Group A, subjects with an IPSS baseline ≥13 behaved similarly to L.I.F.T. subjects. Age, prostate volume, site of service, prior cancer treatment, and diabetic status did not significantly affect PUL outcomes. When completed in a clinic office, PUL resulted in less side effects and catheter placement compared to other sites of service. Previous prostate cancer treatment did not elevate adverse events of high concern such as incontinence and infection.Conclusion: PUL performs well in a real-world setting in terms of symptom relief, morbidity, and patient experience for all studied patient cohorts.

Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia.

A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of prostate (TURP) for the management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). A recent addition to these is prostatic urethral lift (PUL). To assess the effects of PUL for the treatment of LUTS in men with BPH. We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up until 31 January 2019. We included parallel group randomized controlled trials (RCTs). While we planned to include non-RCTs if RCTs had provided low-certainty evidence for a given outcome and comparison, we could not find any non-RCTs. Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used the GRADE approach to rate the certainty of the evidence. We included two RCTs with 297 participants comparing PUL to sham surgery or TURP. The mean age was 65.6 years and mean International Prostate Symptom Score was 22.7. Mean prostate volume was 42.2 mL. We considered review outcomes measured up to and including 12 months after randomization as short-term and later than 12 months as long-term. For patient-reported outcomes, lower scores indicate more urological symptom improvement and higher quality of life. In contrast, higher scores refers to better erectile and ejaculatory function.PUL versus sham: based on one study of 206 randomized participants with short follow-up (up to three months), PUL may lead to a clinically important improvement in urological symptom scores (mean difference (MD) -5.20, 95% confidence interval (CI) -7.44 to -2.96; low-certainty evidence) and likely improves quality of life (MD -1.20, 95% CI -1.67 to -0.73; moderate-certainty evidence). We are uncertain whether PUL increases major adverse events (very low-certainty evidence). There were no retreatments reported in either study group by three months. PUL likely results in little to no difference in erectile function (MD -1.40, 95% CI -3.24 to 0.44; moderate-certainty evidence) and ejaculatory function (MD 0.50, 95% CI -0.38 to 1.38; moderate-certainty evidence).PUL versus TURP: based on one study of 91 randomized participants with a short follow-up (up to 12 months), PUL may result in a substantially lesser improvement in urological symptom scores than TURP (MD 4.50, 95% CI 1.10 to 7.90; low-certainty evidence). PUL may result in a slightly reduced or similar quality of life (MD 0.30, 95% CI -0.49 to 1.09; low-certainty evidence). We are very uncertain whether PUL may cause fewer major adverse events but increased retreatments (both very low-certainty evidence). PUL probably results in little to no difference in erectile function (MD 0.80, 95% CI -1.50 to 3.10; moderate-certainty evidence), but probably results in substantially better ejaculatory function (MD 5.00, 95% CI 3.08 to 6.92; moderate-certainty evidence).With regards to longer term follow-up (up to 24 months) based on one study of 91 randomized participants, PUL may result in a substantially lesser improvement in urological symptom score (MD 6.10, 95% CI 2.16 to 10.04; low-certainty evidence) and result in little worse to no difference in quality of life (MD 0.80, 95% CI 0.00 to 1.60; low-certainty evidence). The study did not report on major adverse events. We are very uncertain whether PUL increases retreatment (very low-certainty evidence). PUL likely results in little to no difference in erectile function (MD 1.60, 95% CI -0.80 to 4.00; moderate-certainty evidence), but may result in substantially better ejaculatory function (MD 4.30, 95% CI 2.17 to 6.43; low-certainty evidence).We were unable to perform any of the predefined secondary analyses for either comparison.We found no evidence for other comparisons such as PUL versus laser ablation or enucleation. PUL appears less effective than TURP in improving urological symptoms both short-term and long term, while quality of life outcomes may be similar. The effect on erectile function appears similar but ejaculatory function may be better. We are uncertain about major adverse events short-term and found no long-term information. We are very uncertain about retreatment rates both short-term and long-term. We were unable to assess the effects of PUL in subgroups based on age, prostate size, or symptom severity and also could not assess how PUL compared to other surgical management approaches. Given the large numbers of alternative treatment modalities to treat men with LUTS secondary to BPH, this represents important information that should be shared with men considering surgical treatment.

Beyond medications: office-based procedures for benign prostatic obstruction.

When medications fail to satisfactorily treat bothersome lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), procedural treatments are indicated. There is much interest in minimally invasive office-based treatments which can be performed under local anesthesia, allow fast recovery and have minimal morbidity. The purpose of this article is to review recent literature regarding safety and efficacy of office-based minimally invasive therapies for BPO. A literature search using PUBMED and Medline was performed regarding minimally invasive office-based treatments for BPO, including the prostatic urethral lift (Urolift), water vapor therapy (Rezum) and stents. Literature published within the last 5years were reviewed. The prostatic urethral lift (Urolift) is a safe and efficacious treatment for LUTS-BPO whilst also preserving sexual function. Rezum appears to be a safe and effective treatment in Phase 2 trials. Memokath prostatic stents do not appear to be a durable treatment; Allium prostatic stents warrant further investigation prior to recommendation. The prostatic urethral lift (Urolift) is a safe and effective treatment for LUTS-BPO whilst preserving sexual function. Rezum also appears to be a safe and effective treatment in small RCTs comparing performance with TURP. Memokath prostatic stents do not appear to have treatment durability. Further studies would be warranted to determine whether Allium prostatic stents are safe effective treatments for LUTS-BPO.

PD24-08 PROSTATIC URETHRAL LIFT (PUL) SYMPTOM AND SEXUAL FUNCTION RESULTS MAINTAINED IN THE TREATMENT OF ALL TYPES OF PROSTATE ENLARGEMENT INCLUDING OBSTRUCTIVE MIDDLE LOBE

INTRODUCTION AND OBJECTIVES:The evidence showing that the Prostatic Urethral Lift (PUL) delivers excellent results with low morbidity has been based on studies of men with lateral lobe enlargement ...

002 12 Month Sexual Function Results of the Prostatic Urethral Lift for Obstructive Middle Lobe

002 12 Month Sexual Function Results of the Prostatic Urethral Lift for Obstructive Middle Lobe

1102 - The prostatic urethral lift (Urolift) versus the convection water vapor ablation (Rezūm) for minimally invasive treatment of BPH: A comparison of improvements and durability in 3-year clinical outcomes

1102 - The prostatic urethral lift (Urolift) versus the convection water vapor ablation (Rezūm) for minimally invasive treatment of BPH: A comparison of improvements and durability in 3-year clinical outcomes

1113 - Pulling the Foley: Can the prostatic urethral lift be used in men with catheter dependent urinary retention?

1113 - Pulling the Foley: Can the prostatic urethral lift be used in men with catheter dependent urinary retention?

Novel Surgical Treatments for Benign Prostatic Enlargement

Transurethral resection of the prostate (TURP) has been the gold standard for the treatment of elderly men with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). However, over the last few years, advances in surgical treatment have led to the development of other treatment modalities. These innovations include convective WAter Vapor Energy (WAVE; Rezum System), prostatic urethral lift (PUL; UroLift System), Prostate Artery Embolisation (PAE) and Aquablation (AQUABEAM System). This review provides an update on these current minimal invasive surgical treatments. The evidence of their safety, tolerability and efficacy in clinical practice is reviewed.

Current and emerging mechanical minimally invasive therapies for benign prostatic obstruction.

Transurethral resection of the prostate (TURP) is considered the ‘gold standard’ for the surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). However, during recent years TURP has been challenged by several minimally invasive therapies (MITs). The reasons for the development of these MITs are the need for anesthesia and the rather unchanged morbidity of TURP, including ejaculation disorders. Mechanical MITs may represent an attractive option for treating LUTS/BPO by using mechanical forces to maintain urethral patency without cutting, ablating, heating or removing prostatic tissue. The present paper provides an update on currently available mechanical devices for the treatment of LUTS/BPO including the prostatic urethral lift (PUL), the temporary implantable nitinol device, and new intraprostatic implants. It analyzes the evidence for their safety, tolerability, and efficacy in clinical practice and aims to define those subpopulations of patients who will benefit from these MITs. It is obvious that there is a wide variation in the degree of mature of the available mechanical MITs. Time and high-quality long-term studies will decide which of these therapies will be accepted by patients and urologists. At the moment, PUL is claiming its position in the armamentarium of BPO treatment.

Signal voids created by prostatic urethral lift implants - a reminder in the era of multiparametric MRIs of the prostate.

The prostatic urethral lift (Urolift ®) is a new and increasingly popular minimally invasive treatment for benign prostatic hyperplasia which is being offered in lieu of ablative or cavitating therapy. The procedure serves to pin aside the prostatic lobes to improve lower urinary tract symptoms. In this patient with a history of extensive implants, MRI was requested as part of his evaluation for a raised PSA. It became clear that the Urolift implant created a signal void which made it difficult to radiologically assess the entirety of the prostate gland. Patients who have had the procedure done and in whom an MRI is being sought, should be counselled on the potential limitations and radiologists should be made aware of the implants.

Prostatic Urethral Lift (PUL) for obstructive median lobes: 12 month results of the MedLift Study

Evidence indicating Prostatic Urethral Lift (PUL) delivers significant improvement in symptomatic BPH with low morbidity is based on subjects with lateral lobe (LL) enlargement only. MedLift was an FDA IDE extension of the L.I.F.T. randomized study designed to examine safety and efficacy of PUL for treatment of obstructive middle lobes (OML). Inclusion criteria for this non-randomized cohort were identical to the L.I.F.T. randomized study, except for requiring an OML: ≥ 50 years of age, IPSS ≥ 13, and Qmax ≤ 12 ml/s. Primary endpoint analysis quantified improvement in IPSS over baseline and rate of post-procedure serious complications. Quantification of symptom relief, quality of life, flow rate, and sexual function occurred through 12 months. Outcomes were compared to historical L.I.F.T LL results and were combined to demonstrate the full effectiveness of PUL. Of the 71 screened subjects, 45 were enrolled. At 1, 3, 6, and 12 months, mean IPSS improved from baseline at least 13.5 points (p < 0.0001). Quality of life and BPHII were similarly improved (>60% and >70%, respectively at 3, 6, and 12 months, p < 0.0001). Mean Qmax improvement ranged from 90 to 129% (p < 0.0001). At 1 month, 86% (CI 73–94%) reported ≥70 on the Quality of Recovery scale, 80% (CI 66–89%) reported being “much” or “very much better,” and 89% (CI 76–95%) would recommend the procedure. Compared to LL subjects, OML subjects’ symptoms improved at least as much at every time point (OML range 13.5–15.9, LL range 9.9–11.1, p ≤ 0.01). On combining OML with LL data, >70% (range CI 63–81%) of subjects demonstrated ≥ 8 point improvement in IPSS through 12 months. Analysis of the combined dataset indicates ≥ 40% (CI 30–51%) of sexually active men improved the minimal clinically important difference in erectile function through 12 months. Prostates, including those with middle lobe obstruction, can be treated with the PUL procedure safely and effectively.