Preservation of Sexual Function with the Prostatic Urethral Lift: A Novel Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Abstract

Introduction We investigated the prostatic urethral lift, a novel, minimally invasive treatment for symptomatic lower urinary tract complaints presumed to be from benign prostatic hyperplasia (BPH), which aims to mechanically open the prostatic urethra without ablation or resection. We hypothesized that this novel approach would not degrade erectile or ejaculatory function. Aims We sought to determine the effect of the prostatic urethral lift procedure on erectile and ejaculatory function. Methods The procedure was performed on 64 men in Australia with an average age of 66.9 years and an average duration of lower urinary tract symptom (LUTS) of 4.7 years. Primary inclusion criteria included International Prostate Symptom Score (IPSS) > 13, Qmax of 5–12 mL/second, and prostate specific antigen (PSA) < 10 ng/mL. Baseline IPSS was 22.9 ± 5.4 (N = 64). There were no inclusion criteria for sexual function. Baseline Sexual Health Inventory for Men (SHIM) was 11.7 ± 8.6 (N = 58); baseline Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) function score was 9.0 ± 3.7 (N = 46); and lack of sexual activity or unwillingness to answer sexual function questionnaires accounted for the reduced sample size in the sexual function instruments. Implants were placed to separate encroaching lateral prostatic lobes. Main Outcome Measures Patients were evaluated at 6 weeks and 3, 6, and 12 months postprocedure via the SHIM and MSHQ-EjD instruments. Results There was no evidence of degradation in sexual function after treatment for LUTS with the prostatic urethral lift procedure. Erectile function, as measured by SHIM, was slightly increased at all time points as compared with baseline. No patient reported retrograde ejaculation at any follow-up visit. Conclusions We demonstrated significant improvement in LUTS with no evidence of degradation in erectile or ejaculatory function after treatment with the prostatic urethral lift procedure. This procedure warrants further study as a new option for patients underserved by current treatments for LUTS/BPH.

Minimally Invasive Treatment for Male Lower Urinary Tract Symptoms: the Prostatic Urethral Lift

“…The rapid and stable treatment response for LUTS with preservation of sexual function achieved by PUL has been confirmed in additional clinical trials [14,[20][21][22]. Indeed, a systematic review and meta-analysis were performed, confirming the therapeutic potential of PUL [23].…”

Treatments for Benign Conditions of the Prostate Gland

“…Using several validated sexual function instruments in 40 patients undergoing PUL [ 92 ], there was minimal impact on erectile function and the majority of patients did not complain of retrograde ejaculation. Approximately 30-50 % of patients will require a postoperative catheter, hematuria and UTIs occur occasionally (<5 %), and fewer than 10 % of patients experience irritative symptoms.…”

Optimizing Population Health and Economic Outcomes: Innovative Treatment for BPH

“…[25][26][27][28][29] Improvement in urinary symptoms, indicated by reduction in AUASI, has been consistent across the various studies, showing rapid relief within 2 weeks and sustained effect to 2 years ( Figure 5). Over 450 patient-years of data have been presented in peer-reviewed publications to date.…”

“…1,[32][33] Moreover, Woo et al demonstrated that, in addition to maintaining erectile function for men entering the study with no or mild ED, erectile function improved for men who entered the study with severe ED. 27 Building on the substantial evidence to date, additional studies are being undertaken. A second European randomized study is currently enrolling patients, a randomized study is planned in France, and open label studies are under way in several countries.…”