Minimally Invasive Prostatic Urethral Lift: Surgical Technique and Multinational Experience

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• 作者：Thomas A. McNicholas ; Henry H. Woo ; Peter T. Chin ; Damien Bolton ; Manuel Fern¨¢ndez Arjona ; Karl-Dietrich Sievert ; Martin Schoenthaler ; Ulrich Wetterauer ; Eric J.E.J. Vrijhof ; Steven Gange ; Francesco Montorsi
• 关键词：Benign prostatic hyperplasia ; Lower urinary tract symptoms ; Prostatic urethral lift ; Minimally invasive surgical procedure ; Prostate ; Therapy ; Urethra
• 刊名：European Urology
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：64
• 期：2
• 页码：292-299
• 全文大小：1699 K

文摘

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 (Q_max), 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 Q_max 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.