Minimally Invasive Surgery for Benign Prostatic Obstruction

New Insights and Future Technical Standards

Enrique Rijo; Richard Hindley; Shahin Tabatabaei; Thorsten Bach

Disclosures

Curr Opin Urol. 2021;31(5):461-467. 

In This Article

Prostatic Urethral Lift

The Urolift (Neotract Inc., Pleasanton, CA, USA) is a nonablative technique based on mechanically opening the prostatic urethra with permanent suture-based implants delivered under cystoscopic guidance, creating a channel from bladder neck to the verumontanum. The prostatic urethral lumen is mechanically widened to relieve the obstruction using nitinol capsular anchor implants that create a transprostatic tissue compression.

The indications for the standard technique are glands < 80 g without an obstructing median lobe, however, Rukstalis et al. have reported that the obstructive median lobe can be treated safely and efficiently using a modified prostatic urethral lift (PUL) technique with similar results to the standard only lateral lobes technique.[4]

The procedure can be performed in an office-based setting under local anesthesia and normally catheterisation is not required.[5]

PUL has been shown to provide durable improvement in LUTS associated with BPH. At 5-year follow-up, International Prostate Symptom Score (IPSS) scores improved by a mean of 35%, urine flow rates improved 50%. PUL has been shown to successfully preserve sexual function, with no significant changes in IIEF-5 or MSHQ-EjD scores.[5] No anejaculation was reported after the procedure.

The 5-year surgical retreatment is 13.6% and the medical retreatment rate is 10.7%.

Sievert et al.[6] offered PUL as an alternative to TURP to 86 patients in a prospective and multicentric study. They reported a significant improvement in mean IPSS (51%), Quality of Life (QoL) (52%), post-void residual volume (PVR) (70%) and Qmax (27%) over the 2 year follow-up. Eleven patients (12.8%) reported persistent LUTS, 9 of which were retreated with TURP and 1 with another PUL procedure.

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