Prostatic urethral lift (PUL), which the FDA approved for use in 2013, now accounts for approximately one-third of all surgeries for benign prostatic hyperplasia (BPH), according to study data presented at the 2022 American Urological Association annual meeting in New Orleans, Louisiana.

Analysis of de-identified and self-reported American Board of Urology case logs showed that PUL use increased from 1.6% of all BPH surgeries in 2015 to 32.5% in 2020, Samantha L. Thorogood, MD, of New York Presbyterian/Weill Cornell Medicine in New York, New York, reported on behalf of her research team.

The study also identified factors associated with performing PUL, which included andrology subspecialization, higher surgeon BPH surgical volume, and non-academic practice types.

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Dr Thorogood and colleagues identified 4131 urologists who performed 48,610 surgeries for BPH from 2015 to 2021. They also identified 786 urologists who performed 7895 PUL procedures, including 24 who performed only PUL procedures, and 3345 who did not use PUL.

In adjusted analyses, andrology subspecialization was significantly associated with 4.0-fold increased odds of performing PUL procedures compared with general urology practice, Dr Thorogood reported. Compared with urologists in academic facilities, those in private practice groups had significant 2.7-fold increased odds of using PUL. Each per-case increase in BPH surgical volume was significantly associated with 2% increased odds of performing PUL procedures.

Urologists practicing in an area with a population higher than 1 million had significant 55% increased odds of performing PUL procedures compared with those practicing in areas with a population less than 100,000.

Endourology subspecialization was significantly associated with 60% lower odds of performing the procedures compared with general practice.

Factors not associated with PUL use included geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age, according to the investigators.

“Given that PUL has been proposed as an alternative therapy to the gold standard TURP in the 2021 BPH surgical guidelines [from the American Urological Association] with its utility limited to prostates under 80 grams without significant median lobe hypertrophy in men who particularly desire ejaculation preservation, the rapid adoption of PUL demonstrated in this study is likely in part influenced by other incentives,” Dr Thorogood told Renal & Urology News. “Patient-driven incentives may include direct-to consumer marketing and increased visibility of PUL technology as well as avoidance or decrease in time under anesthesia and catheterization time.”

Physician-driven incentives may include reimbursement practices, marketing of PUL technology to providers, and ease of use in office practice, such as diminished anesthesia costs without routine post-procedure hospital admission, Dr Thorogood said. These incentives may explain why the odds of performing PUL are higher among group private practice urologists compared with academic urologists.


Thorogood SL, Zhang TR, Sze C, et al. Factors associated with use of prostatic urethral lift (PUL). Presented at AUA 2022, May 13-16, 2022, New Orleans, Louisiana. Poster MP01-07.