Minimally Invasive Prostatic Urethral Lift: Surgical Technique and Multinational Experience

McNicholas, Tom; Woo, Henry H.; Chin, Peter; Bolton, Damien; Arjona, Manuel Fernández; Sievert, Karl Dietrich; Schoenthaler, Martin; Wetterauer, Ulrich; Vrijhof, Eric; Gange, Steven; Montorsi, Francesco

doi:10.1016/j.eururo.2013.01.008

Cited by 109 publications

(93 citation statements)

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“…Finally, no patients required more invasive treatments (i.e., TURP) during the follow-up period, further demonstrating the efficacy (at least measured in a short follow-up period) of the procedure. We consider this result noteworthy when compared with other techniques [10,29,30].…”

Section: Discussionmentioning

confidence: 81%

“…However, non-significant increases in Q max at the different time points were reported. In a recent multinational experience, the IPSS, IPSS QoL score and Q max significantly improved 1 year after the procedure, yet 6.5% of the patients progressed to TURP within 1 year [10].…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, TEAP is still considered experimental and should be used only in trials [5,20]. More recently, the PUL procedure has been proposed as a novel, minimally invasive technique to improve LUTS due to BPH [9,10]. In the PUL procedure, the lateral lobes of the prostate Mean +/-SE Mean +/-SD are displaced by small suture-based implants towards the capsule with the aim of expanding the urethral lumen [9,10,27].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, the PUL procedure has been proposed as a novel, minimally invasive technique to improve LUTS due to BPH [9,10]. In the PUL procedure, the lateral lobes of the prostate Mean +/-SE Mean +/-SD are displaced by small suture-based implants towards the capsule with the aim of expanding the urethral lumen [9,10,27]. In the first clinical experience with 19 patients, at 1 year after PUL the mean IPSS decreased by 39% compared with the baseline value [9].…”

Section: Discussionmentioning

confidence: 99%

“…However, their position in the management of BPH is still controversial [5,7]. More recently, a step in this direction was made: some reports presented data about a new procedure called prostate urethral lift (PUL) [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

et al. 2015

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ObjectivesTo report the first clinical experience with a temporary implantable nitinol device (TIND; Medi-Tate â ) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Patients and MethodsIn all, 32 patients with LUTS were enrolled in this prospective study, which was approved by our Institutional Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) of ≥10, maximum urinary flow rate (Q max ) of ≤12 mL/s, and prostate volume of <60 mL. The TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to the Clavien system), functional results and quality of life (QoL) were evaluated. Follow-up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. The Student's t-test, analysis of variance (ANOVA), Kruskall-Wallis test, and simple and multiple linear regression models were used in the statistical analyses. ResultsThe mean patient age was 69.4 years, the mean (standard deviation, SD) prostate volume was 29.5 (7.4) mL and the Q max was 7.6 (2.2) mL/s. The median (interquartile range, IQR) IPSS was 19 (14-23) and QoL score was 3 (3-4). All the implantations were successful, with no intraoperative complications recorded. The mean operative time (SD) was 5.8 (2.5) min and the median (IQR) postoperative stay was 1 (1-2) day. All but one of the devices (96%) was removed 5 days at after implantation in an outpatient setting. Four complications (12.5%) were recorded, including urinary retention (one, 3.1%), transient incontinence due to device displacement (one, 3.1%), prostatic abscess (one, 3.1%), and urinary tract infection (one, 3.1%). Multiple regression analysis failed to identify any independent prognostic factor for complications. There were statistically significant differences in the IPSS, QoL score and Q max when comparing pre-and postoperative results at every time point. After 12 months, the median (IQR) IPSS and QoL score were 9 (7-13) and 1 (1-2), respectively, and the mean (SD) Q max was 12 (4.7) mL/s. The mean variations with respect to baseline conditions at the same time points were À45% for the IPSS and +67% for Q max . At 12 months after surgery (last followup visit), no patients required medical therapy or surgical procedures for BPH. ConclusionTIND implantation is a feasible and safe minimally invasive option for the treatment of BPH-related LUTS. The functional results are encouraging and the treatment significantly improved patient QoL. Further studies are required to assess durability of TIND results and to optimise the indications of such a procedure.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

et al. 2015

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The Prostatic Urethral Lift Procedure Using UroLift Implants

Rukstalis

2018

Smith's Textbook of Endourology

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Outcomes of prostatic urethral lift in a medically complex population at a veterans affairs hospital

et al. 2021

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Objective: The objective of this study is to report "real-world" outcomes of prostatic urethral lift (PUL) in a medically complex US military veteran population while employing liberalized procedural indications.Methods: A retrospective review was conducted of patients who underwent PUL at our institution. There were no prostatic size requirements, patients were accepted on anti-platelet/anticoagulant therapy, no benign prostatic hyperplasia (BPH) medication washout was required, and there was no maximum post-void residual PVR.Pre-and post-operative International Prostate Symptom Score (IPSS), uroflowmetry, and PVR were recorded. Statistical comparisons were performed using simple t tests.Results: From 2013 to 2019, 91 patients underwent PUL. Mean age was 70 (range 55-92) years. The majority of our patients were classified as American Society of Anesthesiologists (ASA) class 3 versus the general population at ASA class 2. Postoperatively, IPSS decreased by an average of 43% (23 to 13, p < 0.001). There was a mean 41% decrease in PVR (179 to 101 cc, p = 0.009), which was durable for a follow-up of up to 54 months. Maximum urinary flow rate improved by an average of 32% (9.3 to 12.3 cc/s, p = 0.003), which was also durable throughout followup. Forty-four patients required catheterization pre-operatively and 16 required catheterization post-operatively. Therefore, 27 patients (61.4%) were rendered catheter-free by PUL. Thirty-nine patients were taking antiplatelet medications perioperatively, and 13 took anticoagulants. Only one patient (on warfarin) experienced hematuria requiring re-admission with catheter placement.Conclusions: PUL produced effective and durable results in our veteran population, including in patients with significant pre-operative bladder decompensation and those on antiplatelets/anticoagulants.

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Minimally Invasive Prostatic Urethral Lift: Surgical Technique and Multinational Experience

Cited by 109 publications

References 10 publications

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

The Prostatic Urethral Lift Procedure Using UroLift Implants

Outcomes of prostatic urethral lift in a medically complex population at a veterans affairs hospital

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