Prostatic urethral lift (UroLift): a real-world analysis of outcomes using hospital episodes statistics

Abstract

Background To determine real-world outcomes of prostatic urethral lift (UroLift) procedures conducted in hospitals across England. Methods A retrospective observational cohort was identified from Hospital Episode Statistics data including men undergoing UroLift in hospitals in England between 2017 and 2020. Procedure uptake, patient demographics, inpatient complications, 30-day accident and emergency re-attendance rate, requirement for further treatment and catheterization were captured. Kaplan–Meier and hazard analysis were used to analyse time to re-treatment. Results 2942 index UroLift procedures from 80 hospital trusts were analysed; 85.3% conducted as day-case surgery (admitted to hospital for a planned surgical procedure and returning home on the same day). In-hospital complication rate was 3.4%. 93% of men were catheter-free at 30 days. The acute accident and emergency attendance rate within 30 days was 12.0%. Results of Kaplan Meier analysis for subsequent re-treatment (including additional UroLift and endoscopic intervention) at 1 and 2 years were 5.2% [95% CI 4.2 to 6.1] and 11.9% [10.1 to 13.6] respectively. Conclusions This real-world analysis of UroLift shows that it can be delivered safely in a day-case setting with minimal morbidity. However, hospital resource usage for catheterization and emergency hospital attendance in the first 30 days was substantial, and 12% required re-treatment at 2 years.

Complications and device failures associated with urolift: Findings from the MAUDE database

“…This is consistent with multiple ‘real world’ studies where procedural review of patient demographics reveals extreme ages including over 90 years. 10,11…”

“…This is consistent with multiple 'real world' studies where procedural review of patient demographics reveals extreme ages including over 90 years. 10,11 The volume of bleeding associated complications could be related to urolift being performed in larger vascular prostates. While the European Association of Urology (EAU) guidelines recommend candidates for urolift being patients with prostate burdens <70 ml, urolift surgery in patients with burdens over 100 ml and even 200 ml have been reported in the literature.…”

“…It is possible that professionals may selectively choose to report those events that are more serious and unusual rather than those which occur more commonly and are more recognised in the complication profile such as acute urinary retention. While number of major complications have been reported previously such as pelvic haematoma requiring embolisation and implant placement over the ureteric orifice causing obstruction and calyceal rupture, the majority of clinical studies report serious events to occur only very rar ely 10,11,[14][15][16][17][18][19][20][21][22][23][24] (Table 2). Moreover, several studies report no major complications to have occurred whatsoever.…”

Rezum to the rescue: Early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement

“…The 5-year surgical retreatment rates were reported to be 4.4% with the most common transient mild adverse events including dysuria (16.9%), hematuria (11.8%), hematospermia (7.4%), urinary frequency and urgency of 13.6% at 5 years, that is, 2%-3% per year (Roehrborn et al, 2017). Page et al (2021) showed that in a real-world analysis of outcomes, Urolift had a higher retreatment rate of 11.9% at 2 years and hence surgeons had a lower threshold to offer Urolift itself as retreatment outside of clinical trials and patients had to undergo an alternate intervention for recurrent LUTS after Urolift. In our study cohort, 5 of the 19 patients had to seek a redo procedure within 2 years and had a median prostate volume of 64.0 ml.…”

Office-Based Procedures for BPH

“…Overall, the majority (> 95%) of complications in Urolift are minor in nature (Clavien grade 1) [26]. In a recent retrospective observational cohort study out of England, 99/2942 (3.4%) patients reported inpatient complications, with the most common adverse events being urinary retention (1.4%) followed by bleeding (0.9%) [27]. Furthermore, studies have demonstrated that sexual function appears to be preserved in PUL.…”