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Urodynamic effects of prostatic urethral lift procedure for male voiding LUTS.

AIMS
Primary objective is to investigate whether prostatic urethral lift (PUL) results in an improvement of urodynamic parameters that define bladder outlet obstruction (urethral resistance algorithm [URA], Schäfer grade, PdetQmax, PdetOpen).


METHODS
20 patients (main inclusion criteria: ≥ 50 years of age, BPO, IPSS ≥ 13, prostate volume ≤ 60 mL, no middle prostate lobe) were enrolled in the study and a PUL was performed. Patients underwent urodynamic investigation and filled out the IPSS and QoL before and after PUL. A paired T test was used to analyze the results.


RESULTS
The mean age was 68 years (range 55-79), mean prostate volume (TRUS) was 45 mL (range 20-59) and mean PSA was 2.0 ug/L (0.2-4.4). IPSS of the 16 patients reduced significantly (from 22.20 to 14.47, p=0.000). Qmax during pressure flow study improved significantly (from 4.5 ml/s to 7.2 ml/s, p=0.001), no significant difference was found in Qmax during free uroflowmetry. There was no significant difference found in post voiding residual. URA decreased significantly post treatment (from 52 cmH2O to 37 cmH2O, p=0.000). The Schäfer obstruction plot decreased significantly (from 3.5 to 2.6, p= 0.022). Seven patients underwent Greenlight Laser Vaporization of the prostate after the PUL due to unsatisfactory results.


CONCLUSIONS
PUL has desobstructive effects, but they seem clinically modest. The procedure improves urodynamic parameters as well as QoL in males with LUTS based on BPO. However, the mechanism how PUL leads to a remarkable symptom relieve remains unclear and cannot be explained by the desobstructive mechanisms we observed.