Minimally invasive prostatic urethral lift: Surgical technique and multinational experience

Thomas A. McNicholas, Henry H. Woo, Peter T. Chin, Damien Bolton, Manuel Fernández Arjona, Karl Dietrich Sievert, Martin Schoenthaler, Ulrich Wetterauer, Eric J E J Vrijhof, Steven Gange, Francesco Montorsi

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: Many men with benign prostatic hyperplasia (BPH) are dissatisfied with current treatment options. Although transurethral resection of the prostate (TURP) remains the gold standard, many patients seek a less invasive alternative. Objective: We describe the surgical technique and results of a novel minimally invasive implant procedure that offers symptom relief and improved voiding flow in an international series of patients. Design, setting, and participants: A total of 102 men with symptomatic BPH were consecutively treated at seven centers across five countries. Patients were evaluated up to a median follow-up of 1 yr postprocedure. Average age, prostate size, and International Prostate Symptom Score (IPSS) were 68 yr, 48 cm3, and 23, respectively. Surgical procedure: The prostatic urethral lift mechanically opens the prostatic urethra with UroLift implants that are placed transurethrally under cystoscopic visualization, thereby separating the encroaching prostatic lobes. Outcome measurements and statistical analysis: Patients were evaluated pre- and postoperatively by the IPSS, Quality-of-Life (QOL) scale, Benign Prostatic Hyperplasia Impact Index, maximum flow rate (Qmax), and adverse event reports including sexual function. Results and limitations: All procedures were completed successfully with a mean of 4.5 implants without serious adverse effects. Patients experienced symptom relief by 2 wk that was sustained to 12 mo. Mean IPSS, QOL, and Qmax improved 36%, 39%, and 38% by 2 wk, and 52%, 53%, and 51% at 12 mo (p <0.001), respectively. Adverse events were mild and transient. There were no reports of loss of antegrade ejaculation. A total of 6.5% of patients progressed to TURP without complication. Study limitations include the retrospective single-arm nature and the modest patient number. Conclusions: Prostatic urethral lift has promise for BPH. It is minimally invasive, can be done under local anesthesia, does not appear to cause retrograde ejaculation, and improves symptoms and voiding flow. This study corroborates prior published results. Larger series with randomisation, comparator treatments, and longer follow-up are underway.

Original languageEnglish
Pages (from-to)292-299
Number of pages8
JournalEuropean Urology
Volume64
Issue number2
DOIs
Publication statusPublished - Aug 2013

Fingerprint

Prostatic Hyperplasia
Prostate
Ejaculation
Transurethral Resection of Prostate
Quality of Life
Urethra
Local Anesthesia
Random Allocation
Therapeutics

Keywords

  • Benign prostatic hyperplasia
  • Lower urinary tract symptoms
  • Minimally invasive surgical procedure
  • Prostate
  • Prostatic urethral lift
  • Therapy
  • Urethra

ASJC Scopus subject areas

  • Urology

Cite this

McNicholas, T. A., Woo, H. H., Chin, P. T., Bolton, D., Fernández Arjona, M., Sievert, K. D., ... Montorsi, F. (2013). Minimally invasive prostatic urethral lift: Surgical technique and multinational experience. European Urology, 64(2), 292-299. https://doi.org/10.1016/j.eururo.2013.01.008

Minimally invasive prostatic urethral lift : Surgical technique and multinational experience. / McNicholas, Thomas A.; Woo, Henry H.; Chin, Peter T.; Bolton, Damien; Fernández Arjona, Manuel; Sievert, Karl Dietrich; Schoenthaler, Martin; Wetterauer, Ulrich; Vrijhof, Eric J E J; Gange, Steven; Montorsi, Francesco.

In: European Urology, Vol. 64, No. 2, 08.2013, p. 292-299.

Research output: Contribution to journalArticle

McNicholas, TA, Woo, HH, Chin, PT, Bolton, D, Fernández Arjona, M, Sievert, KD, Schoenthaler, M, Wetterauer, U, Vrijhof, EJEJ, Gange, S & Montorsi, F 2013, 'Minimally invasive prostatic urethral lift: Surgical technique and multinational experience', European Urology, vol. 64, no. 2, pp. 292-299. https://doi.org/10.1016/j.eururo.2013.01.008
McNicholas TA, Woo HH, Chin PT, Bolton D, Fernández Arjona M, Sievert KD et al. Minimally invasive prostatic urethral lift: Surgical technique and multinational experience. European Urology. 2013 Aug;64(2):292-299. https://doi.org/10.1016/j.eururo.2013.01.008
McNicholas, Thomas A. ; Woo, Henry H. ; Chin, Peter T. ; Bolton, Damien ; Fernández Arjona, Manuel ; Sievert, Karl Dietrich ; Schoenthaler, Martin ; Wetterauer, Ulrich ; Vrijhof, Eric J E J ; Gange, Steven ; Montorsi, Francesco. / Minimally invasive prostatic urethral lift : Surgical technique and multinational experience. In: European Urology. 2013 ; Vol. 64, No. 2. pp. 292-299.
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abstract = "Background: Many men with benign prostatic hyperplasia (BPH) are dissatisfied with current treatment options. Although transurethral resection of the prostate (TURP) remains the gold standard, many patients seek a less invasive alternative. Objective: We describe the surgical technique and results of a novel minimally invasive implant procedure that offers symptom relief and improved voiding flow in an international series of patients. Design, setting, and participants: A total of 102 men with symptomatic BPH were consecutively treated at seven centers across five countries. Patients were evaluated up to a median follow-up of 1 yr postprocedure. Average age, prostate size, and International Prostate Symptom Score (IPSS) were 68 yr, 48 cm3, and 23, respectively. Surgical procedure: The prostatic urethral lift mechanically opens the prostatic urethra with UroLift implants that are placed transurethrally under cystoscopic visualization, thereby separating the encroaching prostatic lobes. Outcome measurements and statistical analysis: Patients were evaluated pre- and postoperatively by the IPSS, Quality-of-Life (QOL) scale, Benign Prostatic Hyperplasia Impact Index, maximum flow rate (Qmax), and adverse event reports including sexual function. Results and limitations: All procedures were completed successfully with a mean of 4.5 implants without serious adverse effects. Patients experienced symptom relief by 2 wk that was sustained to 12 mo. Mean IPSS, QOL, and Qmax improved 36{\%}, 39{\%}, and 38{\%} by 2 wk, and 52{\%}, 53{\%}, and 51{\%} at 12 mo (p <0.001), respectively. Adverse events were mild and transient. There were no reports of loss of antegrade ejaculation. A total of 6.5{\%} of patients progressed to TURP without complication. Study limitations include the retrospective single-arm nature and the modest patient number. Conclusions: Prostatic urethral lift has promise for BPH. It is minimally invasive, can be done under local anesthesia, does not appear to cause retrograde ejaculation, and improves symptoms and voiding flow. This study corroborates prior published results. Larger series with randomisation, comparator treatments, and longer follow-up are underway.",
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