Urethral Lift as a Safe and Effective Procedure for Prostatic Hyplasia Population: A Systematic Review and Meta-Analysis

Abstract

Background: Prostatic urethral lift (PUL) is a relatively new minimally invasive treatment procedure for benign prostatic hyperplasia (BPH). In order to analyze the sustainability of this new protocol, a systematic review and meta-analysis is performed based on the published articles.Methods: We performed a critical review according to the preferred reporting items for systematic review and meta-analysis (PRISMA) and MOOSE guidelines. A total of 818 published articles matched our search terms, and 11 studies met the inclusion criteria. Data of each follow-up time point (1, 3, 6, 12, and 24 months) were analyzed in terms of baseline characteristics and functional and sexual health outcomes. The merged means of each time point were calculated using R package meta and shown in the tendency plot.Results: A total of 1,443 patients who underwent PUL are available for the research. At 24 months, the changes of the three indicators are statistically significant (IPSS 9.40 points, p < 0.001; Qmax 3.39 ml/s, p < 0.001; QoL 1.99 points, p < 0.001) but were not as effective as TURP (from literature). The trend plot shows that, as time goes on, the effect of PUL tends to increase first and then weaken. Three items fitted a meaningful curve: IPSS (slope = −1.378 t = −12.395, p < 0.001), Qmax (slope = −1.382 t = −6.429, p < 0.001), and QoL (slope = −0.218, t = −10.058, p < 0.001). Fitted curves of SHIM and PVR are not statistically significant. The regression reveals that IPSS, Qmax, and QoL could be predicted after accepting PUL.Conclusion: PUL appears to be a safe and effective procedure in selected patients with BPH and can improve the symptoms of urinary tract obstruction. However, it is not as effective as TURP and shows no influence to the objective indicators like PVR.

Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta‐analysis

“…We identified several systematic reviews focusing on MITs, reporting similar findings concerning the efficacy of TIND, PUL, PAE and WVTT, and highlighting that these are relatively effective treatments, with a lower incidence of adverse events and sexual dysfunction, compared to TURP [73][74][75][76][77][78]. While some of these findings are similar to those of the present review, we highlight the uncertainty surrounding some of these outcomes, especially those related to sexual function, in which the data are sparse and usually available for only a subset of participants in each study, as was highlighted by one review [79].…”

Comparative efficacy and safety of prostatic urethral lift vs prostatic artery embolization for benign prostatic hyperplasia: a systematic review and network meta‐analysis

“…However, there are discrepancies regarding the effectiveness of PAE and PUL when compared with TURP. These are largely attributed to variability in the studies included in the meta‐analyses, since some used both non‐randomized trials and RCTs due to the scarcity of RCTs published [36,37,40]. This may have introduced a bias in their results, which should therefore be interpreted with caution.…”

“…The greater improvement of objective outcomes in TURP can own resective procedures remove greater amount of prostatic tissue creating a wider‐open prostatic fossa, and consequently a greater relief of BOO [35]. Recent meta‐analyses have also demonstrated that TURP produces better improvements in most patient outcomes compared with PAE [36–39] and PUL [35,40,41]. However, there are discrepancies regarding the effectiveness of PAE and PUL when compared with TURP.…”

“…The advantage of the new interventions is their minimally invasive nature, leading to better postoperative sexual function and fewer AEs. The safety profile of PUL has been demonstrated in recent RCTs [8,43] and meta‐analyses [35,40,41]. Similarly, PAE is also believed to have fewer side effects relating to sexual function and to result in fewer AEs [44,45].…”