Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia

Abstract

Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects.

UroLift: a new minimally-invasive treatment for benign prostatic hyperplasia

“…In an era fuelled by advancements in minimally-invasive technologies, the 'UroLift' device (NeoTract Inc., Pleasanton, CA, USA), formally known as the prostatic urethral lift (PUL), is the latest addition to the surgical toolkit available to urologists treating men with bothersome lower urinary tract symptoms (LUTS) secondary to BPH [Jones et al 2016a]. This nonablative minimally-invasive option is postulated to deliver sustainable improvements in functional outcomes while maintaining a strong safety profile and causing minimal de novo sexual dysfunction [Garcia et al 2015]. Key objectives for any new surgical intervention are to demonstrate clinical efficacy, safety, long-term durability and economic feasibility.…”

Prostatic Urethral Lift Vs Prostate Arterial Embolization: Novel Nonablative Strategies in the Management of Lower Urinary Tract Symptoms Secondary to Benign Prostate Hyperplasia

“…Once the urethral end piece is attached to the monofilament, the latter is then cut. Owing to the tissue-sparing nature of the procedure, which allows for preservation of bladder neck integrity (implants 6 should therefore be deployed atleast 1.5cm distal to this site and angulated carefully), antegrade ejaculation is protected [18]. The result is retraction of the encroaching lateral lobes and therefore expansion of the urethral lumen without causing compromise to vital anatomical structures such as the primary neurovascular bundles and the dorsal venous complex.…”

“…Avoiding the use of a thermal energy source is thought to keep the risk of erectile dysfunction to a minimum. The number of implants installed per case is adenoma dependent and ranges between 2 to 10 according to Garcia et al [18]. Larger prostates require more implants.…”

“…An Australian group led by Henry Woo, at the University of Sydney, has largely pioneered this novel device [17,18,19]. They carried out their debut PUL procedure in 2005 and in 2011 published results from a prospective, cohort study in 19 men [17].…”

Urininkontinenz beim Mann – ein Tabuthema

“…Neben der TUR-P, die als Goldstandard zur Deobstruktion der Prostata gilt, gibt es auch neuere alternativen Verfahren wie zum Beispiel die transurethrale LASER-oder Plasma-Vaporisation der Prostata mit bis anhin ähnlichen postoperativen Ergebnissen im mittelfristigen Verlauf [18,19]. Bei minimalinvasiven Verfahren wie zum Beispiel dem UroLift, ist die Datenlage zu den postoperativen Ergebnissen aktuell ungenügend [20].…”