Predictors of durability of the prostatic urethral lift (PUL) for benign prostatic hyperplasia

There is a need to understand the predictors of prostatic urethral lift (PUL) durability to help physicians counsel patients and optimize outcomes.

A simple logistic regression analysis was performed on a pooled dataset of 331 subjects across 5 PUL controlled studies with up to 5 years follow up. Predictors of "surgical durability" (no surgical treatment for return of symptoms) and "total durability" (no surgical or medical treatment for return of symptoms) were assessed at 1- and 5-year post-procedure.

Placing ≤4 implants regardless of baseline prostate volume was associated with increased surgical retreatment within the first year. Through one year, more implants were protective of retreatment; for every incremental implant placed, surgical retreatment odds decreased an additional 41.2% and risk of combined surgical or medical retreatment decreased 30.2%. Higher implant density was also protective through one year; for each additional implant placed per 10cc prostate volume, surgical retreatment odds decreased incrementally by 79.0%. Up to 5 years, a higher baseline pretreatment IPSS score predicted higher rates of surgical or medical retreatment; for every one-point score increase of baseline IPSS, surgical or medical retreatment odds increased 5.2%. Baseline demographics, medical history and baseline sexual function were not predictors of surgical or total durability.

More implants, higher implant density, and lower baseline IPSS are all associated with decreased surgical and medical retreatment rates up to 5 years following PUL. These findings inform optimizing PUL technique, considering earlier intervention and counseling men on outcomes prior to PUL.