Two-year longitudinal changes in pressure-flow study parameters and prostate morphology after prostatic urethral lift

The long-term changes in bladder outlet obstruction (BOO) and prostate morphology after prostatic urethral lift (PUL) remain poorly understood. We evaluated longitudinal changes in pressure-flow study (PFS) parameters and magnetic resonance imaging (MRI) findings over 2 years after PUL.

We retrospectively analyzed 27 patients with benign prostatic hyperplasia who underwent PUL and completed 24-month follow-up. Questionnaires and free uroflowmetry were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. PFS and prostate MRI were performed preoperatively and at 6 and 24 months postoperatively. Longitudinal changes in key PFS and MRI parameters were analyzed using linear mixed-effects models adjusted for BPH medication class.

The median age was 76 years, and symptomatic improvement was sustained for 24 months. In mixed-effects models adjusted for BPH medication class, significant overall time effects were observed for PdetQmax and BOOI (both p = 0.003). Compared with baseline, both PdetQmax and BOOI were significantly reduced at 6 months (Holm-adjusted p = 0.002 for both), whereas their subsequent increases between 6 and 24 months were not statistically significant after adjustment (p = 0.082 and p = 0.065, respectively). PFS Qmax showed no significant longitudinal change. Prostate and transition zone volumes showed significant overall time effects, with increases between 6 and 24 months, whereas baseline-to-24-month differences were not significant after multiple-comparison adjustment.

Symptomatic improvement after PUL was sustained for 2 years. Urodynamic parameters demonstrated an early reduction in voiding pressure and calculated outlet resistance, although their longer-term changes should be interpreted cautiously. Prostate morphology also changed during follow-up, with increases in prostate and transition zone volumes between 6 and 24 months.