Best Practices & Benign Disease
Introduction & Objective :
Benign prostatic hyperplasia (BPH) with associated lower urinary tract symptoms (LUTS) has a significant impact on quality of life. Multi-institutional projects have demonstrated Prostatic urethral lift (PUL) as a minimally invasive procedure with strong 5-year durability, minimal side effect profile, and no associated erectile or ejaculatory dysfunction. Long term single series data are needed. We aim to evaluate the performance of PUL in our single series community cohort.
We completed a retrospective chart review of men who underwent PUL in the office from January 2016 to August 2017. PUL, also known as Urolift (NeoTract, Pleasanton, CA, USA), was performed in the office under sedation by a single surgeon. International prostatic symptom score (IPSS) and quality of life (QOL) were recorded at baseline and at subsequent office visits. A paired-samples T-test was used to compare pre and post treatment values and a Pearson coefficient was used to determine the strength of relationships between variables. A value of p<0.05 was set as the threshold for statistical significance.
We identified 122 men who had undergone a PUL. Descriptive statistics demonstrated an average age of 69.5 + 9.6, prostate volume of 51.6 + 27.8, and number of implants used 5.5 + 1.0. When comparing IPSS and QOL 83 and 80 paired samples were available and the mean follow up period was 9.3 + 6.03 months. IPSS values improved significantly from 20.4 + 6.2 to 6.3 + 4.7 (-14.08 + 6.6 p+ 1.0 to 1.4 + 1.3 (-2.82 +1.4 p<0.05). Significant relationships existed between both pre-operative IPSS and IPSS score difference (IPSS at last follow up – preoperative IPSS) r = -0.731 (p<0.05) and QOL and QOL difference r = -0.463 (p<0.05). The number of implants used was found to be associated with prostate volume (r = 0.492 p<0.05) but not IPSS or QOL score differences.
Our single surgeon series demonstrated statistically significant improvement in IPSS and QOL at an average of 9 months. In addition, initial IPSS and QOL scores were found to significantly correlate with IPSS and QOL score improvements. Continued follow up is needed to compare our results against previously published data.