Less Invasive Prostatic Lift Beats Transurethral Resection

Kate Johnson

March 21, 2016

MUNICH — For men with urinary symptoms from benign prostatic hyperplasia, outcomes are better with a surgically implanted prostatic urethral lift (UroLift, NeoTract) than with traditional transurethral resection of the prostate, two new studies show. And results with the lift are durable out to 4 years.

The findings from both studies — LIFT and BPH-6 — were presented here at the European Association of Urology 2016 Congress.

"I would consider urethral lift as an option for patients," said session chair Grégoire Robert, MD, PhD, professor of urology at Université de Bordeaux in France.

However, he pointed out that long-term results are lacking. Patients treated with the prostatic urethral lift might eventually need back-up medication to control their symptoms, "which can be considered a treatment failure and needs to be further explored," he told Medscape Medical News.

In the LIFT study, 13% of the lift patients underwent some form of retreatment during the 4-year study period. And in the BPH-6 study, 9% of the lift patients underwent secondary treatment during the 2-year study period.

The LIFT Study

In the prospective, blinded, randomized LIFT study, 140 patients from Australia, Canada, and the United States underwent implantation of a prostatic urethral lift. The 66 patients in the control group who underwent a sham procedure were allowed cross over to receive a lift at 3 months.

"This study demonstrates a durable effect of the prostatic urethral lift," said LIFT investigator Neil Barber, MD, a consultant urologic surgeon at Frimley Park Hospital NHS Foundation Trust in Surrey, United Kingdom.

The 44% improvement in urinary symptoms seen at 1 month, measured with the International Prostate Symptom Score (IPSS), was sustained at 4 years (P < .0001). And at 4 years, there was also a 62% improvement in urinary flow, measured with Qmax.

In North America, the minimally invasive procedure was performed almost entirely under local anesthesia. Mean duration of the procedure was 66 minutes, and it was a mean of 8.6 days until the patients returned to full normal activity.

In addition, "only 32% of patients required a postoperative catheter, and usually for less than a day," Dr Barber reported. In fact, the mean duration was 0.9 days.

The BPH-6 Study

In the prospective, multicenter BPH-6 study, 45 patients underwent implantation of a prostatic urethral lift and 35 underwent traditional transurethral resection of the prostate.

At 2 years, the composite end point — which included lower urinary tract symptoms, recovery, sexual function, continence, and safety — was significantly better with the lift than with transurethral resection (46% vs 22%; P < .05).

However, examination of individual parameters of the composite end point revealed pros and cons for each procedure, said study investigator Christian Gratzke, MD, professor of urology at the University of Munich.

The improvement in lower urinary tract symptoms, defined as a reduction in IPPS of at least 30%, was significantly better after transurethral resection than after the lift (91% vs 62%; P = .01). However, recovery at 1 month, defined as an improvement of at least 70% on a visual analogue scale, was better with the lift (82% vs 53%; P < .01).

"Erectile function was not hampered in any of the groups, which is a very good sign because it means that transurethral resection of the prostate was actually done well. But while ejaculatory function was preserved in 100% of the lift patients, there was significant impairment, which is hardly surprising, in the transurethral resection arm [P < .01]," Dr Gratzke reported.

 
The BPH-6 study looked at parameters that are much more patient- than physician-focused, which is a very novel approach.
 

For lower urinary tract symptoms in patients with benign prostatic hyperplasia, "virtually every approach carries some risk of negative impact on sexual function, but here we have this new technology that has no negative impact on erectile or ejaculatory function," said Henry Woo, MD, associate professor of surgery at the University of Sydney in Australia.

He added that the composite end point of BPH-6 is an important step forward in studies of benign prostatic hyperplasia.

When you look at the classic outcomes physicians tend to use to judge treatment success, "transurethral resection looks better than the lift," Dr Woo told Medscape Medical News. "But the BPH-6 study looked at parameters that are much more patient- than physician-focused, which is a very novel approach," he pointed out.

"When you look at patient-centered outcomes, the lift looks much better than transurethral resection, in that it is effective in treating urinary symptoms and preserving sexual function. A lot of urologists are still trying to get their heads around the idea of patient-centered, rather than physician-centered, outcomes," Dr Woo explained.

Both studies were sponsored by NeoTract. Dr Barber reports a financial relationship with NeoTract. Claus Roehrborn, MD, from the University of Texas Southwestern Medical Center in Dallas, who was principal investigator of LIFT, reports a financial relationship with NeoTract. Dr Woo reports a financial relationship with NeoTract. Dr Robert and Dr Gratzke have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2016 Congress: Abstracts 1076 and 1077. Presented March 14, 2016.

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