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.
Similar content being viewed by others
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
References
Cornu J-N, Cussenot O, Haab F, Lukacs B (2010) A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines. Eur Urol 58:450–456. https://doi.org/10.1016/j.eururo.2010.05.045
Reich O, Gratzke C, Bachmann A et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180:246–249. https://doi.org/10.1016/j.juro.2008.03.058
McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185:1793–1803. https://doi.org/10.1016/j.juro.2011.01.074
Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50:969–980. https://doi.org/10.1016/j.eururo.2005.12.042
Arai Y, Aoki Y, Okubo K et al (2000) Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function: a prospective study. J Urol 164:1206–1211
Rosen RC, Riley A, Wagner G et al (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830
Woo HH, Chin PT, McNicholas TA et al (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 108:82–88. https://doi.org/10.1111/j.1464-410X.2011.10342.x
Sønksen J, Barber NJ, Speakman MJ et al (2015) Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. https://doi.org/10.1016/j.eururo.2015.04.024
Gratzke C, Bachmann A, Descazeaud A et al (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67:1099–1109. https://doi.org/10.1016/j.eururo.2014.12.038
McNicholas TA, Woo HH, Chin PT et al (2013) Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol 64:292–299. https://doi.org/10.1016/j.eururo.2013.01.008
Trockman BA, Gerspach J, Dmochowski R et al (1996) Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men. J Urol 156:1418–1420
Lourenco T, Shaw M, Fraser C et al (2010) The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J Urol 28:23–32. https://doi.org/10.1007/s00345-009-0496-8
Rosen RC, Catania JA, Althof SE et al (2007) Development and validation of four-item version of male sexual health questionnaire to assess ejaculatory dysfunction. Urology 69:805–809. https://doi.org/10.1016/j.urology.2007.02.036
Cantwell AL, Bogache WK, Richardson SF et al (2014) Multicentre prospective crossover study of the “prostatic urethral lift” for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: PUL for the treatment of LUTS. BJU Int 113:615–622. https://doi.org/10.1111/bju.12540
Perera M, Roberts MJ, Doi SAR, Bolton D (2015) Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol 67:704–713. https://doi.org/10.1016/j.eururo.2014.10.031
Marberger H (1974) The mechanisms of ejaculation. Basic Life Sci 4:99–110
Gallizia P (1972) The smooth sphincter of the vesical neck, a genital organ. Urol Int 27:341–354
Dorschner W, Stolzenburg JU, Neuhaus J (2001) Anatomic principles of urinary incontinence. Urol Ausg A 40:223–233
Hermabessiere J, Guy L, Boiteux JP (1999) Human ejaculation: physiology, surgical conservation of ejaculation. Prog En Urol J Assoc Fr Urol Société Fr Urol 9:305–309
Alloussi SH, Lang C, Eichel R, Alloussi S (2014) Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique. J Endourol 28:84–89. https://doi.org/10.1089/end.2013.0093
Bachmann A, Tubaro A, Barber N et al (2014) 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial—The GOLIATH Study. Eur Urol 65:931–942. https://doi.org/10.1016/j.eururo.2013.10.040
Roehrborn CG (2016) Prostatic urethral lift: a unique minimally invasive surgical treatment of male lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urol Clin North Am 43:357–369. https://doi.org/10.1016/j.ucl.2016.04.008
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
Authors and Affiliations
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
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.
Rights and permissions
About this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-018-2232-8