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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

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusion

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

DRKS00008970.

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Fig. 1

Abbreviations

BOO:

Bladder outlet obstruction

BPH:

Benign prostatic hyperplasia

CURP:

Combined prostatic urethral lift and remodeling of the prostate and bladder neck

LUTS:

Lower urinary tract symptoms

PUL:

Prostatic urethral lift

Qmax:

Peak flow rate

PVR:

Post void residual volume

IPSS:

International Prostate Symptom Score

ICIQ:

International Consultation on Incontinence Modular Questionnaire Short form

IIEF:

International Index of erectile function

QoL:

Quality of life

TUR-P:

Transurethral resection of the prostate

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Acknowledgments

The study was supported by institutional funding (University Medical Center Freiburg), no external or industrial funding was received.

Funding

Institutional (University Medical Center Freiburg), no external or industrial funding. This project was realized with institutional funding (University Medical Center Freiburg), no external or industrial funding was received.

Author information

Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Konrad Wilhelm.

Ethics declarations

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.

Ethical standard

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”.

Ethical approval

504/14, Ethic committee University Medical center Freiburg.

Informed consent

All participants gave their informed consent prior to their inclusion in the study.

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Cite this article

Schoenthaler, M., Sievert, KD., Schoeb, D.S. et al. 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. World J Urol 36, 1111–1116 (2018). https://doi.org/10.1007/s00345-018-2232-8

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Keywords

  • Lower urinary tract symptoms
  • Transurethral resection of prostate
  • Ejaculation
  • Prostatic urethral lift