Combined prostatic urethral lift and remodeling of the prostate and bladder neck: a modified transurethral approach in the treatment of symptomatic lower urinary tract obstruction
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The aim of the study was to evaluate the feasibility and safety of combining prostatic urethral lift (PUL) and a limited resection of the prostatic middle lobe or bladder neck incision in the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).
Twenty-eight patients were treated at two tertiary centers and followed prospectively. Patient evaluations included patient characteristics, relief of LUTS symptoms, erectile and ejaculatory function, continence, operative time and adverse events. Patients were followed for a mean of 10.9 months.
Patient characteristics were as follows: age 66 years (46–85), prostate volume 39.6 cc (22–66), preoperative IPSS/AUASI 20 (6–35)/QoL 3.9 (1–6)/peak flow 10.5 mL/s (4.0–19)/post-void residual volume (PVR) 123 mL (0–500). Mean operating time was 31 min (9–55). Postoperative complications were minor except for the surgical retreatment of one patient for blood clot retention (Clavien 3b). One patient required catheterization due to urinary retention. Reduction of symptoms (IPSS − 59.6%), increase in QoL (+ 49.0%), increase in flow (+ 111.5%), and reduction of PVR (− 66.8%) were significant. Antegrade ejaculation was always maintained.
Our data suggest that a combination of PUL and transurethral surgical techniques is feasible, safe, and effective. This approach may be offered to patients with moderate size prostates including those with unfavorable anatomic conditions for PUL. This procedure is still ‘minimally invasive’ and preserves sexual function. In addition, it may add to a higher functional efficacy compared to PUL alone.
Study register number
KeywordsLower urinary tract symptoms Transurethral resection of prostate Ejaculation Prostatic urethral lift
Bladder outlet obstruction
Benign prostatic hyperplasia
Combined prostatic urethral lift and remodeling of the prostate and bladder neck
Lower urinary tract symptoms
Prostatic urethral lift
Peak flow rate
Post void residual volume
International Prostate Symptom Score
International Consultation on Incontinence Modular Questionnaire Short form
International Index of erectile function
Quality of life
Transurethral resection of the prostate
The study was supported by institutional funding (University Medical Center Freiburg), no external or industrial funding was received.
MS: Protocol/project development, Manuscript writing/editing, surgical procedures. DSS: Manuscript writing. AM: Artwork, supervisor and adviser. TK: Data collection and management. SH: Data management. TRWH: Manuscript writing/editing. KW: Protocol/project development, data collection and management, data analysis, manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
MS was a consultant in contract with Schoelly GmbH, Denzlingen, Germany, and conducts workshops for NeoTract Inc., Pleasanton, USA. AM was a consultant in contract with Schoelly GmbH, Denzlingen. KS conducts workshops for Neotract Inc., Pleasanton, USA. The other authors declare no conflicts of interest.
The study has been approved by the local ethics committee. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors”.
504/14, Ethic committee University Medical center Freiburg.
All participants gave their informed consent prior to their inclusion in the study.
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