Prostatic Urethral Lift: Does Size Matter?

摘要

Objectives: To assess if prostatic urethral lift (PUL) can be as effective on larger prostates. PUL is an endoscopic device that retracts prostatic tissue to relieve benign prostatic hypertrophy (BPH) obstruction. In 2013, PUL was approved for patients with a prostate size of 80g and no median lobes. The approval was primarily based on the L.I.F.T. study, which only evaluated patients with prostates between 30 and 80g in size. Materials and Methods: Seventy-four patients underwent PUL between April 2, 2014, and December 2, 2015, for BPH management. Fifty-one patients were in the 80g prostate group (median: 46g, range: 20-78g) and 23 in the 80g prostate group (median: 112g, range: 81-254g). Student t-tests and Fisher's exact tests were used to compare continuous and categorical variables. p-Value of 0.05 was considered statistically significant. Results: Median time between PUL and follow-up AUA symptom score (AUASS) was 144 days. A difference between the numbers of PUL implants used was seen. A significant improvement in AUASSs was seen in both groups following the procedure. There was no significant difference in age, AUASS before or after the procedure, or need for an additional outlet procedure between the two groups. Conclusion: Early experience finds that a sufficient number of men with larger prostates appear to benefit from PUL. Patients with 80g prostate size were more likely to have a median lobe and may benefit from resection of the median lobe at time of the PUL. Long-term follow-up is needed to evaluate the durability of the PUL procedure.