Minimally invasive prostatic urethral lift: surgical technique and multinational experience.
BACKGROUND
Many men with benign prostatic hyperplasia (BPH) are dissatisfied with current treatment options. Although transurethral resection of the prostate (TURP) remains the gold standard, many patients seek a less invasive alternative.


OBJECTIVE
We describe the surgical technique and results of a novel minimally invasive implant procedure that offers symptom relief and improved voiding flow in an international series of patients.


METHODS
A total of 102 men with symptomatic BPH were consecutively treated at seven centers across five countries. Patients were evaluated up to a median follow-up of 1 yr postprocedure. Average age, prostate size, and International Prostate Symptom Score (IPSS) were 68 yr, 48 cm(3), and 23, respectively.


METHODS
The prostatic urethral lift mechanically opens the prostatic urethra with UroLift implants that are placed transurethrally under cystoscopic visualization, thereby separating the encroaching prostatic lobes.


METHODS
Patients were evaluated pre- and postoperatively by the IPSS, Quality-of-Life (QOL) scale, Benign Prostatic Hyperplasia Impact Index, maximum flow rate (Qmax), and adverse event reports including sexual function.


CONCLUSIONS
All procedures were completed successfully with a mean of 4.5 implants without serious adverse effects. Patients experienced symptom relief by 2 wk that was sustained to 12 mo. Mean IPSS, QOL, and Qmax improved 36%, 39%, and 38% by 2 wk, and 52%, 53%, and 51% at 12 mo (p<0.001), respectively. Adverse events were mild and transient. There were no reports of loss of antegrade ejaculation. A total of 6.5% of patients progressed to TURP without complication. Study limitations include the retrospective single-arm nature and the modest patient number.


CONCLUSIONS
Prostatic urethral lift has promise for BPH. It is minimally invasive, can be done under local anesthesia, does not appear to cause retrograde ejaculation, and improves symptoms and voiding flow. This study corroborates prior published results. Larger series with randomisation, comparator treatments, and longer follow-up are underway.
Lister Hospital and University of Hertfordshire, Stevenage, UK. tom.mcnicholas@nhs.net
Thomas A
TA
McNicholas
Henry H
HH
Woo
Peter T
PT
Chin
Damien
D
Bolton
Manuel
M
Fernández Arjona
Karl-Dietrich
KD
Sievert
Martin
M
Schoenthaler
Ulrich
U
Wetterauer
Eric J E J
EJ
Vrijhof
Steven
S
Gange
Francesco
F
Montorsi
D000368:Aged; D001315:Australia; D005060:Europe; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011467:Prostate / Q000503:physiopathology / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D019919:Prosthesis Implantation / Q000295:instrumentation; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D014481:United States; D014521:Urethra / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000295:instrumentation
Benign prostatic hyperplasia; Lower urinary tract symptoms; Minimally invasive surgical procedure; Prostate; Prostatic urethral lift; Therapy; Urethra