How I Do It: The prostatic urethral lift for obstructive median lobes

Area of Science:

• Urology
• Minimally Invasive Surgery
• Men's Health

Background:

• Millions of men experience lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).
• Medical therapy for BPH often suffers from poor patient adherence.
• Existing surgical options may present barriers such as sexual dysfunction, incontinence, and prolonged recovery.

Purpose of the Study:

• To evaluate the efficacy and safety of Prostatic Urethral Lift (PUL) for treating obstructive median lobe BPH.
• To describe the technique and new device for performing PUL on median lobe obstructions.
• To assess patient-reported outcomes and functional preservation following PUL for median lobe BPH.

Main Methods:

• Review of randomized controlled trials and large real-world multicenter/database studies on PUL.
• Analysis of patient data from controlled trials and retrospective studies for median lobe PUL.
• Description of the current surgical technique and a novel device for median lobe PUL.

Main Results:

• PUL demonstrated significant improvement in IPSS (11.6-13.5 points) and quality of life (2.1-3.0 points) at 12 months for median lobe BPH.
• Improvements in maximum flow rate (Qmax) were observed (6.4-7.1 mL/sec).
• Erectile and ejaculatory functions were preserved, with short catheterization duration (mean 1.2 days).

Conclusions:

• Prostatic Urethral Lift is a safe and effective treatment for lower urinary tract symptoms caused by obstructive median lobe BPH.
• PUL offers a minimally invasive alternative addressing key patient concerns regarding sexual function and recovery.
• Technological advancements, including new devices, enhance PUL's applicability to complex trilobar anatomy.