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Meta-analysis and systematic review of intermediate-term follow-up of prostatic urethral lift for benign prostatic hyperplasia

  • Urology - Review
  • Published:
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Abstract

Background

Prostatic urethral lift (PUL), is a relatively new minimally invasive procedure for treatment of benign prostatic hyperplasia (BPH).This article is a systematic review and meta-analysis of all the articles published including follow-up of at least 24 months to analyze sustainability of results.

Methods

We performed a critical review in according to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. From a total 768 published articles that matched our search terms, 5 studies with minimum follow-up of 24 months were selected for comparison and data analyzed in terms of baseline characteristics, functional, and sexual health outcomes.

Results

Included in the analyses are five studies with a minimum follow-up of 24 months. A total of 386 patients underwent PUL and 322 patients (83.4%) are available for follow-up at 24 months. The randomized studies are grouped as group A and non-randomized studies as group B. At 24 months, the mean reduction in International Prostate Symptom Score (IPSS) from baseline was 9.1 in group A and 10.4 in group B. The mean improvement in peak flow rate (Qmax) was 3.7 mL/s in group A and 3 mL/s in group B, and quality of life (QoL) improved by 2.2 in both groups.

Conclusion

PUL is a well-tolerated, minimally invasive therapy for BPH that provides favorable and durable symptomatic, sexual health, and functional outcomes up to 24 months. Longer follow-up and randomized studies comparing to current standards are required to further confirm the long-term sustainability of PUL.

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Abbreviations

PUL:

Prostatic urethral lift

BPH:

Benign prostatic hyperplasia

LUTS:

Lower urinary tract symptoms

TURP:

Transurethral resection of prostate

TUNA:

Transurethral needle ablation

TUMT:

Transurethral microwave thermotherapy

IPSS:

International prostate symptom score

Qmax:

Peak flow rate

PVR:

Post-void residual

QOL:

Quality of life

MSHQ-EjD:

Male Sexual Health Questionnaire for Ejaculatory Dysfunction

MSHQ-Bother:

Male Sexual Health Questionnaire for Ejaculation bother

References

  1. St Sauver JL, Jacobson DJ, Girman CJ, Lieber MM, McGree ME, Jacobsen SJ (2006) Tracking of longitudinal changes in measures of benign prostatic hyperplasia in a population based cohort. J Urol 175(3 Pt 1):1018–1022. https://doi.org/10.1016/s0022-5347(05)00408-8(discussion 980)

    Article  PubMed  Google Scholar 

  2. Ally M, Lee T, Ecclestone H, Teo L, Kavia R (2017) Malignant features of a benign waiting list. J Clin Urol 10(2):105–109

    Article  Google Scholar 

  3. Roehrborn CG (2011) Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin 95(1):87–100

    Google Scholar 

  4. Verhamme KM, Dieleman JP, Bleumink GS, Bosch JL, Stricker BH, Sturkenboom MC (2003) Treatment strategies, patterns of drug use and treatment discontinuation in men with LUTS suggestive of benign prostatic hyperplasia: the Triumph project. Eur Urol 44(5):539–545. https://doi.org/10.1016/s0302-2838(03)00376-2

    Article  CAS  PubMed  Google Scholar 

  5. Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–979. https://doi.org/10.1016/j.eururo.2005.12.042(discussion 980)

    Article  PubMed  Google Scholar 

  6. Magistro G, Chapple CR, Elhilali M, Gilling P, McVary KT, Roehrborn CG, Stief CG, Woo HH, Gratzke C (2017) Emerging minimally invasive treatment options for male lower urinary tract symptoms. Eur Urol 72(6):986–997. https://doi.org/10.1016/j.eururo.2017.07.005

    Article  PubMed  Google Scholar 

  7. Jones P, Rajkumar GN, Rai BP, Aboumarzouk OM, Cleaveland P, Srirangam SJ, Somani BK (2016) Medium-term outcomes of urolift (Minimum 12 Months Follow-up): evidence from a systematic review. Urology 97:20–24. https://doi.org/10.1016/j.urology.2016.05.003

    Article  PubMed  Google Scholar 

  8. Magistro G, Stief CG, Woo HH (2018) Mini-review: what is new in urolift? Eur Urol Focus 4(1):36–39. https://doi.org/10.1016/j.euf.2018.01.013

    Article  PubMed  Google Scholar 

  9. Woo HH, Chin PT, McNicholas TA, Gill HS, Plante MK, Bruskewitz RC, Roehrborn CG (2011) Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BJU Int 108(1):82–88. https://doi.org/10.1111/j.1464-410X.2011.10342.x

    Article  PubMed  Google Scholar 

  10. Chin PT, Bolton DM, Jack G, Rashid P, Thavaseelan J, Yu RJ, Roehrborn CG, Woo HH (2012) Prostatic urethral lift: two-year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 79(1):5–11. https://doi.org/10.1016/j.urology.2011.10.021

    Article  PubMed  Google Scholar 

  11. McNicholas TA, Woo HH, Chin PT, Bolton D, Fernandez Arjona M, Sievert KD, Schoenthaler M, Wetterauer U, Vrijhof EJ, Gange S, Montorsi F (2013) Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol 64(2):292–299. https://doi.org/10.1016/j.eururo.2013.01.008

    Article  PubMed  Google Scholar 

  12. Roehrborn CG, Rukstalis DB, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, Gholami SS, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Borges FD, Rashid P (2015) Three year results of the prostatic urethral LIFT study. Can J Urol 22(3):7772–7782

    PubMed  Google Scholar 

  13. Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, Gholami SS, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Herron S, Rashid P, Rukstalis DB (2017) Five year results of the prospective randomized controlled prostatic urethral LIFT study. Can J Urol 24(3):8802–8813

    PubMed  Google Scholar 

  14. Cantwell AL, Bogache WK, Richardson SF, Tutrone RF, Barkin J, Fagelson JE, Chin PT, Woo HH (2014) Multicentre prospective crossover study of the 'prostatic urethral lift' for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU Int 113(4):615–622. https://doi.org/10.1111/bju.12540

    Article  PubMed  Google Scholar 

  15. Sonksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Montorsi F, Patterson JM, Fahrenkrug L, Schoenthaler M, Gratzke C (2015) Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol 68(4):643–652. https://doi.org/10.1016/j.eururo.2015.04.024

    Article  PubMed  Google Scholar 

  16. Bozkurt A, Karabakan M, Keskin E, Hirik E, Balci MB, Nuhoglu B (2016) Prostatic urethral lift: a new minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urol Int 96(2):202–206. https://doi.org/10.1159/000441850

    Article  CAS  PubMed  Google Scholar 

  17. Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, Schoenthaler M, Sonksen J (2017) Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 119(5):767–775. https://doi.org/10.1111/bju.13714

    Article  PubMed  Google Scholar 

  18. Rukstalis D, Rashid P, Bogache WK, Tutrone RF, Barkin J, Chin PT, Woo HH, Cantwell AL, Cowan BE, Bolton DM (2016) 24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham. BJU Int 118(Suppl 3):14–22. https://doi.org/10.1111/bju.13666

    Article  PubMed  Google Scholar 

  19. Shah BB, Tayon K, Madiraju S, Carrion RE, Perito P (2018) Prostatic urethral lift: does size matter? J Endourol 32(7):635–638. https://doi.org/10.1089/end.2017.0855

    Article  PubMed  Google Scholar 

  20. Sievert KD, Schonthaler M, Berges R, Toomey P, Drager D, Herlemann A, Miller F, Wetterauer U, Volkmer B, Gratzke C, Amend B (2019) Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years. World J Urol 37(7):1353–1360. https://doi.org/10.1007/s00345-018-2494-1

    Article  PubMed  Google Scholar 

  21. Garcia C, Chin P, Rashid P, Woo HH (2015) Prostatic urethral lift: a minimally invasive treatment for benign prostatic hyperplasia. Prostate Int 3(1):1–5. https://doi.org/10.1016/j.prnil.2015.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  22. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  23. Deeks JJ, Higgins JP, Altman DG (2008) Analysing data and undertaking meta‐analyses. Cochrane Handb Syst Rev Interv, pp 241–284

  24. Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148(5):1549–1557. https://doi.org/10.1016/s0022-5347(17)36966-5(discussion 1564)

    Article  CAS  PubMed  Google Scholar 

  25. Rosen RC, Catania J, Pollack L, Althof S, O'Leary M, Seftel AD (2004) Male Sexual Health Questionnaire (MSHQ): scale development and psychometric validation. Urology 64(4):777–782. https://doi.org/10.1016/j.urology.2004.04.056

    Article  PubMed  Google Scholar 

  26. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM et al. (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898 https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  27. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:4919

    Article  Google Scholar 

  28. McGuinness LA (2019) Robvis: an R package and web application for visualising risk-of-bias assessments. https://github.com/mcguinlu/robvis

  29. von Hippel PT (2015) The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med Res Methodol 15:35. https://doi.org/10.1186/s12874-015-0024-z

    Article  Google Scholar 

  30. Strope SA, Vetter J, Elliott S, Andriole GL, Olsen MA (2015) Use of medical therapy and success of laser surgery and transurethral resection of the prostate for benign prostatic hyperplasia. Urology 86(6):1115–1122. https://doi.org/10.1016/j.urology.2015.07.019

    Article  PubMed  Google Scholar 

  31. Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM (2006) Systematic review and meta-analysis of transurethral needle ablation in symptomatic benign prostatic hyperplasia. BMC Urol 6:14. https://doi.org/10.1186/1471-2490-6-14

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hoffman RM, Monga M, Elliott SP, Macdonald R, Langsjoen J, Tacklind J, Wilt TJ (2012) Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004135.pub3

    Article  PubMed  Google Scholar 

  33. Eure G, Gange S, Walter P, Khan A, Chabert C, Mueller T, Cozzi P, Patel M, Freedman S, Chin P, Ochs S, Hirsh A, Trotter M, Grier D (2019) Real-world evidence of prostatic urethral lift confirms pivotal clinical study results: 2-year outcomes of a retrospective multicenter study. J Endourol 33(7):576–584. https://doi.org/10.1089/end.2019.0167

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jung JH, Reddy B, McCutcheon KA, Borofsky M, Narayan V, Kim MH, Dahm P (2019) Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 5:Cd012832. https://doi.org/10.1002/14651858.CD012832.pub2

    Article  PubMed  Google Scholar 

  35. US Department of Health and Human Services CfMaMSPBNSDF (2016) https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Part-B-National-Summary-Data-File/Overview.html.

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Authors and Affiliations

  1. Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA

    Karthik Tanneru, Jatinder Kumar, Muhammad Umar Alam, Shahriar Koocheckpour, K. C. Balaji & Costa Joseph

  2. Department of Biostatistics, University of Florida, Jacksonville, FL, USA

    Shiva Gautam & Daniel Norez

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  1. Karthik Tanneru
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Contributions

TK: project development, data collection, and manuscript writing. GS: data collection and data analysis. ND: data collection and data analysis. KJ: manuscript writing. MA: manuscript writing. SK: manuscript review and editing. BK: data review, manuscript review, and editing. CJ: data review, manuscript review, and editing.

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Correspondence to Costa Joseph.

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Tanneru, K., Gautam, S., Norez, D. et al. Meta-analysis and systematic review of intermediate-term follow-up of prostatic urethral lift for benign prostatic hyperplasia. Int Urol Nephrol 52, 999–1008 (2020). https://doi.org/10.1007/s11255-020-02408-y

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