Early Experiences of a Minimal Invasive Intra-Prostatic Implant, Prostatic Urethral Lift for Benign Prostatic Hyperplasia Treatment in Korea

Jonghyup Yang; Dongho Shin; Jaewoo Sung; Shinjay Cho; Sungmin Kang; Hyun Cheol Jeong; Sae Woong Choi; Woong Jin Bae; Sae Woong Kim

doi:10.14777/uti.2019.14.3.80

Journal List > Urogenit Tract Infect > v.14(3) > 1142157

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yang, Shin, Sung, Cho, Kang, Jeong, Choi, Bae, and Kim: Early Experiences of a Minimal Invasive Intra-Prostatic Implant, Prostatic Urethral Lift for Benign Prostatic Hyperplasia Treatment in Korea

∗∗∗

Urogenit Tract Infect 2019;14(3):80-86.

Published online: 20 January 2019

DOI: https://doi.org/10.14777/uti.2019.14.3.80

Early Experiences of a Minimal Invasive Intra-Prostatic Implant, Prostatic Urethral Lift for Benign Prostatic Hyperplasia Treatment in Korea

Jonghyup Yang, Dongho Shin, Jaewoo Sung, Shinjay Cho, Sungmin Kang, Hyun Cheol Jeong¹, Sae Woong Choi², Woong Jin Bae, Sae Woong Kim

Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

¹Department of Urology, Kangdong Sacred Heart Hospital, Seoul, Korea

²Department of Urology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Sae Woong Kim https://orcid.org/0000-0002-9127-9400 Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-1401, Fax: +82-2-2258-1536 E-mail: ksw1227@catholic.ac.kr

Received 30 May 2019 Revised 4 September 2019 Accepted 9 October 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

As a minimal invasive device for benign prostatic hyperplasia (BPH) treatment, prostatic urethral lift (PUL) is widely accepted worldwide but not widely used in Korea. We investigated the one-year results of for patients with BPH in Korea.

Materials and Methods

From April 2017 to June 2018, 42 patients with BPH were treated with PUL under local anesthesia with sedation. International Prostate Symptom Score (IPSS) and maximum urinary flow rate and post-void residual (PVR) were evaluated preoperatively and 1, 3, 6, and 12 months later.

Results

Mean age was 69.57±8.58 years old, and mean prostatic volume was 37.17±12.19 cc. Preoperative total IPSS and quality of life (QOL) were 19.94±7.81 and 3.69±1.30, respectively. Total IPSS improved to 11.26±7.22 (p<0.001), and QOL was 2.42±1.43 (p=0.01) after one month. Patients showed no evidence of inflammation related to the implants. IPSS and QOL were somewhat worse after 3 months but were better than baseline at 6 and 12 months. Preoperative maximum flow rate (Qmax) was 9.71±5.45 ml/sec, and one month after surgery, it had improved to 12.63±7.33 (p=0.01); it remained good at 3, 6, and 12 months (12.63±7.38, 12.45±7.39, 14.73±9.67). PVR was not significant at any points postoperative (80.61±67.91 to 43.95±8.19, p=0.119). No patient reported retrograde ejaculation, erectile dysfunction or urinary tract infection.

Conclusions

We evaluated the one-year efficacy of PUL for BPH treatment in Korea, and found significant improvement of IPSS, QOL and Qmax. It is expected that not only the improvement of voiding symptom but also the preservation of sexual function with a low risk of adverse events.

Keywords: Keywords, Prostatic hyperplasia, Lower urinary tract symptoms, Transurethral resection of prostate, Adrenergic alpha-antagonists

References

1. Verhamme KM, Dieleman JP, Bleumink GS, Bosch JL, Stricker BH, Sturkenboom MC. Treatment strategies, patterns of drug use and treatment discontinuation in men with LUTS suggestive of benign prostatic hyperplasia: the Triumph project. Eur Urol. 2003; 44:539–45.

2. Roehrborn CG. Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: achievements and limitations. Rev Urol. 2008; 10:14–25.

3. Park HK, Park H, Cho SY, Bae J, Jeong SJ, Hong SK, et al. The prevalence of benign prostatic hyperplasia in elderly men in Korea: a community-based study. Korean J Urol. 2009; 50:843–7.

4. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: diagnosis and treatment recommendations. J Urol. 2003; 170:530–47.

5. Nickel JC, Saad F. The American Urological Association 2003 guideline on management of benign prostatic hyperplasia: a Canadian opinion. Can J Urol. 2004; 11:2186–93.

6. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011; 185:1793–803.

7. Bouza C, López T, Magro A, Navalpotro L, Amate JM. Systematic review and metaanalysis of transurethral needle ablation in symptomatic benign prostatic hyperplasia. BMC Urol. 2006; 6:14.

8. Andersen M, Walter S. [Microwave thermotherapy for benign prostatic hyperplasia. A survey of a Cochrane review]. Ugeskr Laeger. 2009; 171:2281–4. Danish.

9. Chin PT, Bolton DM, Jack G, Rashid P, Thavaseelan J, Yu RJ, et al. Prostatic urethral lift: two-year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology. 2012; 79:5–11.

10. McNicholas TA, Woo HH, Chin PT, Bolton D, Fernández Arjona M, Sievert KD, et al. Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol. 2013; 64:292–9.

11. Jones P, Rai BP, Aboumarzouk OM, Somani BK. Urolift: a new chapter in benign prostate hyperplasia (BPH) therapy. Ann Transl Med. 2016; 4:116.

12. Jones P, Rajkumar GN, Rai BP, Aboumarzouk OM, Cleaveland P, Srirangam SJ, et al. Medium-term outcomes of urolift (minimum 12 months follow-up): evidence from a systematic review. Urology. 2016; 97:20–4.

13. Statistics Korea. Korean Statistical Information Service [Internet]. Daejeon: Statistics Korea;2014. [cited 2018 Oct 5]. Available from:. http://kosis.kr/index/index.do.

14. Lee YJ, Lee JW, Park J, Seo SI, Chung JI, Yoo TK, et al. Nationwide incidence and treatment pattern of benign prostatic hyperplasia in Korea. Investig Clin Urol. 2016; 57:424–30.

15. Barrack ER, Bujnovszky P, Walsh PC. Subcellular distribution of androgen receptors in human normal, benign hyperplastic, and malignant prostatic tissues: characterization of nuclear salt-resistant receptors. Cancer Res. 1983; 43:1107–16.

16. Martin DJ, Mulhall JP. Enlarging the scope of managing benign prostatic hyperplasia: addressing sexual function and quality of life. Int J Clin Pract. 2005; 59:579–90.

17. Ulchaker JC, Martinson MS. Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Clinicoecon Outcomes Res. 2017; 10:29–43.

18. Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol. 2013; 190:2161–7.

19. Cantwell AL, Bogache WK, Richardson SF, Tutrone RF, Barkin J, Fagelson JE, et al. Multicentre prospective crossover study of the ‘prostatic urethral lift'for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU Int. 2014; 113:615–22.

20. Shore N, Freedman S, Gange S, Moseley W, Heron S, Tutrone R, et al. Prospective multicenter study elucidating patient experience after prostatic urethral lift. Can J Urol. 2014; 21:7094–101.

21. Rukstalis DB. Prostatic urethral lift: a novel approach for managing symptomatic BPH in the aging man. Can J Urol. 2015; 22(Suppl 1):67–74.

22. S⊘nksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015; 68:643–52.

23. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol. 2006; 50:969–79. ; discussion 980.

24. Alloussi SH, Lang C, Eichel R, Alloussi S. Ejaculation-preserving transurethral resection of prostate and bladder neck: short-and longterm results of a new innovative resection technique. J Endourol. 2014; 28:84–9.

25. Schoenthaler M, Sievert KD, Schoeb DS, Miernik A, Kunit T, Hein 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. 2018; 36:1111–6.

Fig. 1.

Cystoscopic features before (upper) and after (lower) prostatic urethral lift patients.

Fig. 2.

Preoperative, one, three, six, and 12 months results for prostatic urethral lift. (A) Total International Prostate Symptom Score (IPSS), (B) IPSS voiding score, (C) IPSS storage score, (D) maximum flow rate (Qmax).

Table 1.

Subjects' demographics

Demographics	Value
Age (y)	69.57±8.58
Number of anchors	2.24 (2–4)
Prostate volume (cc)	37.17±12.19
Prostate specific antigen (ng/ml)	2.11±2.10
Total IPSS	19.94±7.81
IPSS voiding	12.06±5.67
IPSS storage	7.11±3.42
IPSS QOL	3.69±1.30
Qmax (ml/sec)	9.71±5.45
PdetQmax (cm/H₂O)	52.34±29.53
BOOI	37.04±29.73
BCI	90.59±35.55
Schäfer grade	2.58±1.30
PVR (ml)	80.61±67.91

Values are presented as mean±standard deviation or average (range). IPSS: International Prostate Symptom Score, QOL: quality of life, Qmax: maximum flow rate, PdetQmax: detrusor pressure at peak flow rate, BOOI: bladder outlet obstruction index, BCI: bladder contractility index, PVR: post-void residual.

Table 2.

Change in the outcomes after prostatic urethral lift: one month to 12 months

Parameter	Baseline (n=42)	1 month (n=42)	3 months (n=42)	6 months (n=25)	12 months (n=5)
IPSS	19.94±7.81	11.26±7.22	11.74±7.08	15.38±6.79	13.33±9.02
p-value		＜0.001	＜0.001	0.001	0.18
IPSS voiding	12.06±5.66	5.71±5.17	6.67±5.34	8.62±4.48	7±6
p-value		＜0.001	0.002	0.02	0.126
IPSS storage	7.11±3.42	5.55±2.64	5.07±2.43	6.77±3.00	6.33±3.06
p-value		0.004	0.001	0.03	0.057
IPSS QOL	3.69±1.30	2.42±1.43	2.22±1.37	2.77±1.48	3±1
p-value		0.01	0.64	0.636	0.573
Qmax (ml/sec)	9.71±5.45	12.63±7.33	12.63±7.38	12.45±7.39	14.73±9.67
p-value		0.01	0.002	0.03	0.324
PVR (ml)	80.61±67.91	43.95±8.19	33.23±48.81	31.65±39.71	19.33±17.01
p-value		0.119	0.003	0.206	0.5

Values are presented as mean±standard deviation. IPSS: International Prostate Symptom Score, QOL: quality of life, Qmax: maximum flow rate, PVR: post-void residual. p-value compares clinical differences from baseline.

Table 3.

Overview of adverse events over one year after the prostatic urethral lift

Adverse events	0–1 month	1–3 months	3–6 months	6–12 months
Total available subjects	42	32	18	5
Related adverse events	5	1	0	0
Clavien grade 1
Dysuria	1 (2.4)	0	0	0
Urinary retention	3 (7.1)	1 (3.1)	0	0
Hematuria	1 (2.4)	0	0	0
Urinary tract infection	0	0	0	0
Erectile dysfunction	0	0	0	0
Retrograde ejaculation	0	0	0	0
Clavien grade 2	0	0	0	0

Values are presented as number only or number (%).

TOOLS

Similar articles