Prostatic Urethral Lift Relieves Symptoms of Benign Prostatic Hyperplasia

June 20, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Jun 20 - Prostatic urethral lift, a minimally invasive procedure, relieves lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), according to a new study.

"This may become a good treatment option for in-office treatment, but this is just one study and only time will tell," Dr. Claus G. Roehrborn from The University of Texas Southwestern Medical Center in Dallas told Reuters Health by email.

Dr. Roehrborn and colleagues tested the efficacy and safety of the prostatic urethral lift (PUL) procedure in a randomized, blinded, sham-controlled trial of 206 men (140 assigned to PUL, 66 assigned to sham control) with BPH at 19 centers in three countries. The trial, known as L.I.F.T. study, was published online June 12 in The Journal of Urology.

During the procedure, transprostatic adjustable UroLift implants are permanently implanted to retract obstructing lateral lobes and expand the urethral lumen. All procedures were completed successfully without perioperative serious adverse events and with an overall mean procedure time of 66.2 minutes and an average of 4.9 implants per patient.

At three months' follow-up, patients assigned to PUL had significantly greater improvements in American Urological Association Symptom Index (AUASI), peak urinary flow (Qmax), quality of life, and BPH Impact Index, compared with patients assigned to sham control.

All these differences remained significant at six and/or 12 months of follow-up.

One hundred thirty-one PUL patients underwent cystoscopy at 12 months, and independent review of 127 available videos found no strictures, a mild increase in inflammation and edema in only one and five patients, and no evidence of abnormal pathology. There was no evidence of encrustation on implants fully contained within the prostate.

"Misplacement of the implant such that it is exposed to bladder urine may result in encrustation," the researchers caution. "Closely adhering to the technique of implant delivery no closer than 1 cm to the bladder neck and insuring appropriate angulation can avoid this issue. We recommend that, at the end of each PUL, the operator inspect the bladder interior to confirm that no implants are exposed. If detected, the misplaced implant can be easily removed with endoscopic forceps."

Dr. Marc Zerbib from Hopital Cochin, Paris Descartes University in Paris, France, has also studied PUL for BPH. He told Reuters Health in an email that, "It could be one of the recommended treatments for patients like these."

Factors that enter into the decision as to how best to treat these men include, according to Dr. Zerbib, "age, side effects of alpha blockers, maintenance of normal ejaculation, and cost-effectiveness."

Dr. Zerbib pointed to the efficacy of the procedure and the fact that it can be done on an outpatient basis as advantages of PUL.


J Urol 2013.


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