Prostatic urethral lift safe for elderly BHP patients with low prostate volume, finds study

A new study published in the International Journal of Urology found that prostatic urethral lift (PUL) is a safe and successful operation for older patients with comorbidities who have prostate volumes less than 100 mL. A prevalent condition affecting the quality of life (QOL) in older men is benign prostatic hyperplasia (BPH). Lower urinary tract symptoms (LUTS), urine retention, and worsening of bladder function are caused by BPH.

Older males were more likely to have moderate to severe LUTS, which was linked to worse health outcomes and greater difficulty doing everyday tasks. The minimally invasive surgical procedure which is prostate urethral lift (PUL) is less intrusive than traditional prostate surgery. One of the most popular operations for BPH is the PUL procedure with the UroLift® System. The patients with preoperative urine retention who have BPH surgery had a poorer postoperative catheter-free rate than the ones who do not.

Thus, this study used real-world multicenter data to assess the safety and effectiveness of PUL. This study examined the postoperative urinary conditions in patients with preoperative urine retention and the individuals without, as well as prostate volumes of less than 30 mL, 30 mL to 50 mL, and more than 50 mL.

PUL indications were derived from pertinent Japanese standards. Evaluations were made of the preoperative condition, postoperative development at 1 and 3 months, and perioperative complications of the patients. Also, the study examined prostate sizes of less than 30 mL, 30 mL to 50 mL, and more than 50 mL, as well as preoperative urine retention and nonurinary retention individuals.

The research involved a total of160 patients in total. The average prostate volume was 44 mL, and the average age was 75 years. 1 and 3 months after surgery, there was a substantial improvement in the International Prostate Symptom Score, quality of life score, maximal flow rate, and postvoid residual volume as compared to before surgery.

On postoperative days 1, 7, 30, and 90, the preoperative urinary retention group's catheter-free rates were 58.1%, 72.1%, 83.7%, and 88.4%, respectively. On postoperative days 1, 7, and 14, the catheter-free rates of the the nonurinary retention groups were 94.9%, 98.3%, and 100%, respectively.

Among the 3 groups, there was no difference in the postoperative urine status. But, the group with a prostate volume ≥50 mL required considerably more implants and had a longer operation duration. Overall, as long as the prostate volume is less than 100 mL, PUL has been shown to be both safe and effective for treating BPH in elderly individuals with comorbidities.

Reference:

Anan, G., Minami, H., Fujishima, Y., & Kaga, K. (2024). Efficacy and safety of prostatic urethral lift according to preoperative urinary retention and prostate volume: A Japanese real‐world multicenter data. In International Journal of Urology. Wiley. https://doi.org/10.1111/iju.15621