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EAU 2018: Predictors of Response to the Prostatic Urethral Lift (PUL) Treatment

Copenhagen, Denmark (UroToday.com) Benign prostate hyperplasia (BPH) is of significant impact to patients’ quality of life, especially for those with moderate to severe lower urinary symptoms (LUTS). While transurethral resection of the prostate (TURP) is the recommended method of treatment, many patients choose to delay surgical treatment due to concerns of the invasive nature of the procedure and its related side effects of erectile dysfunction.

UroLift has been proposed as a new device for the treatment and management of LUTS symptoms due to BPH. More specifically, UroLift offers an alternative treatment method for patients who are deemed ineligible for surgery due to severe comorbidities.

Dr. Gratzke of San Luigi Gonzaga Hospital Department of Urology in Orbassano, Italy presented a prospective study of 32 patients who were treated with UroLift for LUTS and BPH. Patients were randomized 2:1 to UroLift versus sham surgery. Primary outcome measurement was measured as a responder was defined as a patient who received UroLift and did not require subsequent BPH surgery or medication at 5 years.

Preservation of ejaculation in 100% of patients, this feature is one of the reasons that patients will approach a physician and ask for the procedure. The procedure results not only in the elimination of side effects, but it is also efficacious in treatment of BPH – a response of which is stable throughout five years of follow-up. Multivariate analysis was used to control for possible confounders such as IPSS elements and prostate volume.

Of the 19 centers in North American and Australia, 206 men with symptomatic LUTS were randomized and followed-up from 1 month to 5 years post-procedure. Symptom relief was significant at 1 month and remained improved through five year follow-up (p<0.001). As predicted, IPSS elements of weak stream, incomplete emptying, and prostate volumes (p<0.1) were significant predictors of response to the UroLift procedure.

In discussion, Dr. Gratzke states that the ultimate decision to pursue UroLift should be primarily based on patient preferences. Because preservation of ejaculation in up to 100% of patients is possible, it is noted that this is one of the reasons that patients will pursue the procedure. However, it is important to note that the procedure is efficacious in the treatment of BPH up to five years after the procedure. While TURP remains the gold standard, the UroLift procedure will always appeal to patients and it is up to the physician to have a detailed conversation with the patient regarding the risks and benefits of the procedure.

Authors: Gratzke C. 1 , Barkin J. 2 , Roehrborn C. 3.

Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark