Prostatic Urethral Lift Benefits Confirmed
New data show that the minimally invasive procedure is superior overall to TURP for treating BPH-related lower urinary tract symptoms.
SAN DIEGO—Two new studies presented at the American Urological Association 2016 annual meeting support the use of prostatic urethral lift as a surgical option for men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).
In the first prospective, randomized trial comparing prostatic urethral lift (PUL) and standard transurethral resection of the prostate (TURP), 46% of the 40 BPH/LUTS suffers who underwent PUL responded to the BPH6 primary endpoint at 2 years compared with 22% of 35 men who underwent TURP, Jens Sønksen, MD, PhD, of Herlev Hospital in Herlev, Denmark, and colleagues reported. The BPH6 endpoint measures symptom relief, quality of recovery, erectile function, ejaculatory function, continence preservation, and safety.
With respect to individual components of BPH6, PUL resulted in superior quality of recovery and ejaculatory function, whereas TURP was superior at reducing International Prostate Symptom Score (IPSS) and improving peak flow rate.
PUL and TURP did not differ significantly in their effects on erectile function, continence, and safety.
The new findings are consistent with 12-month results reported last year in European Urology (2015;68:643-652).
Dr. Sønksen's group noted that TURP can be associated with complications such as sexual dysfunction, incontinence, and a lengthy recovery period. PUL is a less invasive alternative that may overcome these limitations.
PUL involves placement of small, permanent metallic implants into the lateral lobes of the prostate that retract the lobes and thereby reduce urinary obstruction.
The second study, the largest and longest trial of the PUL procedure, showed that PUL patients on average achieve rapid and clinically meaningful LUTS relief that can be sustained to 4 years. Claus Roehrborn, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues prospectively studied 206 patients randomly assigned to undergo PUL (140 patients) or a sham control (66 patients). Compared with controls, the PUL patients had an average reduction in IPSS was 44% by 1 month, 50% at 3 months, 47% at 1 year, and 46% at 4 years, the researchers reported. Peak flow rates increased by 64% at 3 months, 59% at 1 year, and 69% at 4 years. PUL patients experienced little morbidity, and sexual function with respect to erection and ejaculation was preserved, they noted.