Urethral Lift for Benign Prostatic Hyperplasia: A Comprehensive Review of the Literature

Abstract

Current treatments for benign prostatic hyperplasia (BPH) include watchful waiting, medical therapy, and interventional procedures. The post-surgical complication profile and the early discontinuation of medical therapy are significant drawbacks of the established approach and stimulate the search for less-invasive approaches. Our aim is to provide a comprehensive review all available literature on prostatic urethral lift (PUL), presenting an overview of safety, indications, surgical technique and results of the procedure, and to evaluate the potential role it could play in the treatment of BPH. A comprehensive search was conduct on PubMed and Scopus database to identify original articles in English dealing with PUL without any limit to publication date. Keywords used were prostatic urethral lift, urethral lifting, Urolift, benign prostatic hyperplasia and minimally invasive therapy. The PUL seems to offer a better IPSS improvement when compared to medical therapy, but the result is inferior when compared to surgical therapy. Published studies report an absence of degradation of erectile or ejaculatory function after treatment, which appears a noteworthy benefit of PUL. Additional advantages of the PUL are a better complication profile in comparison to other surgical therapies and the use of a local anesthesia, sometimes without postoperative catheterization. The PUL, a novel, minimally invasive treatment option for men affected by BPH, presents a promising potential although it is clear that PUL is not a substitute for traditional ablative surgical approach, as this procedure requires a scrupulous selection of the patient.

Efficacy and safety of the urolift® system for the treatment of benign prostate hyperplasia symptoms: Systematic review

“…22 The Urolift ® system emerges as a new therapeutic alternative that acts mechanically separating the prostatic lobes, thus avoiding the risks associated with surgery. 22 The Urolift ® system emerges as a new therapeutic alternative that acts mechanically separating the prostatic lobes, thus avoiding the risks associated with surgery.…”

The Prostatic Urethral Lift Method: A New Minimally Invasive Modality as an Alternative in the Treatment of Benign Prostatic Hyperplasia

“…Böylece lateral loblar prostatın kapsülüne doğru çekilir (Şekil 2). Fibromusküler prostat kapsülü periüretral dokuya kıyasla gerilmeye dayanıklıyken periüretral doku daha esnek olabildiğinden implantın yerleştirilmesinden sonra tıkanıklığa neden olan prostat lobları laterale doğru yer değiştirerek prostatik üretranın açılması sağlanır (5).…”

“…Eşlik eden üriner enfeksiyonu olan hastalarda da yabancı cisim kolonizasyon riski nedeniyle uygulanmamalıdır. Alfa redüktaz inhibitörlerinin 6 ay önce ve alfa blokerlerin en az bir hafta önce kesilerek olası devam eden etkilerinin yapılan işlemin sonucuna etkisi önlenmiş olmalıdır (5). PUA yöntemi literatürde 149 cm 3 hacminde prostata bile uygulanmasına rağmen, özellikle yöntemi öğrenme aşamasında 50 cm 3 'den büyük prostatlara önerilmemektedir (8).…”

“…Medikal tedavi başarısızlığı; hastaların ilaç uyumsuzluğu, ilacın etkinliğinin az olması ve ilaca bağlı yan etkiler nedeniyle olmaktadır (4). Prostatın transüretral rezeksiyonu (TURP) cerrahi tedavinin altın standart yöntemidir (5). TURP AÜSS'nin iyileşmesinde oldukça etkili bir yöntem olmasına rağmen %20 perioperatif morbiditeye ilave olarak ejakülatuvar disfonksiyon (%65), erektil disfonksiyon (%10), üriner inkontinans (%3), tranfüzyon ihtiyacı (%8), transüretral rezeksiyon (TUR) sendromu (%3), üretral darlık ve mesane boynu kontraksiyonu (%7) gibi uzun dönem komplikasyonları da mevcuttur (6).…”

What's truly minimally invasive in benign prostatic hyperplasia surgery?

“…The first, randomized controlled blinded trial demonstrated a reduction in American Urological Association Symptom Index from baseline by 4 points at 2 weeks, 11 points by 3 months, and this reduction remained stable to 1 year. A comprehensive literature review found that although PUL seems to offer a better IPSS improvement when compared to medical therapy, the result is inferior when compared with surgical therapy [17]. The reported advantages of PUL include a low complication profile, preservation of ejaculatory and erectile function, and minimal to no catheter requirement [14,15].…”