Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years

Karl-Dietrich Sievert, Martin Schonthaler, Richard Berges, Patricia Toomey, Desiree Drager, Annika Herlemann, Florian Miller, Ulrich Wetterauer, Bjorn Volkmer, Christian Gratzke, Bastian Amend, Karl-Dietrich Sievert, Martin Schonthaler, Richard Berges, Patricia Toomey, Desiree Drager, Annika Herlemann, Florian Miller, Ulrich Wetterauer, Bjorn Volkmer, Christian Gratzke, Bastian Amend

Abstract

Introduction: Successful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies.

Materials and methods: We investigated the outcome of the PUL procedure at five German departments during the initial period when PUL was approved for the clinic (10/2012-06/2014). All candidates for transurethral resection of the prostate (TURP) received PUL information and were given the choice of procedures. The only exclusion criterion was an obstructive median lobe. No patients were excluded because of high post-void residual volume (PVR), prostate size, retention history or LUTS oral therapy. Maximum urinary flow (Qmax), PVR, International Prostate Symptom Score (IPSS) and Quality of Life (QOL) were assessed at baseline, 1, 6, 12, and 24 months after surgery.

Results: Of 212 TURP candidates, 86 choose PUL. A mean of 3.8 (2-7) UroLift implants were implanted in patients of 38-85 years with a prostate size of 17-111 ml over 57 (42-90) min under general or local anesthesia. Thirty-eight (38.4%) patients had severe BPH obstruction and would have been denied PUL utilizing previously reported study criteria. Within 1 month 74 (86%) reported substantial symptom relief with significant improvements in Qmax, PVR, IPSS, and QOL (p < 0.001) that was maintained within the follow-up. Sexual function including ejaculation was unchanged or improved. No Clavien-Dindo Grad ≥ 2 was reported postoperatively. Eleven (12.8%) patients were retreated over 2 years. Twelve (86%) of 14 patients presenting with chronic urinary retention were catheter free at last follow-up.

Conclusion: PUL is a promising surgical technique that may alleviate LUTS, even in patients with severe obstruction.

Keywords: Benign prostatic hyperplasia (BPH); LUTS; Minimally invasive surgical therapy; Prostatic urethral lift (PUL); Transurethral resection of prostate.

Conflict of interest statement

Karl-Dietrich Sievert Travel grant, BPH study investigator, conducted workshops for Neotract. Martin Schonthaler BPH-6 study investigator, conducted workshops for Neotract. Richard Berges BPH-6 study investigator. Patricia Toomey None. Annika Herlemann None. Florian Miller None. Ulrich Wetterauer BPH-6 study investigator. Christian Gratzke BPH-6 Study Investigator. Bjorn Volkmer None. Bastian Amend None.

Figures

Fig. 1
Fig. 1
IPSS, QOL, Qmax and PVR for 24 months after PUL. Mean and 95% confidence interval

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