Purpose of reviewThere is increasing interest among men who require benign prostatic obstruction (BPO) surgery for treatment, which also preserves sexual function. Transurethral resection of the prostate (TURP) impacts sexual function; some novel treatments claim to preserve it. Concerns exist among

Preservation of sexual function when relieving benign prostatic obstruction surgically: can a trade-off be considered?

The prostatic urethral lift procedure, more commonly known as UroLift, has been designed to improve male lower urinary tract symptoms while avoiding the complications and disadvantages of existing drug and surgical therapies. In particular, UroLift does not damage ejaculatory function or affect orgasmic sensation. It appears an option for men who wish to avoid long-term drug therapy, the side effects of drugs or surgery and who do not need or will not accept traditional surgical treatments. UroLift was introduced following a series of planned studies that led to US Food and Drug Administration approval in September 2013. UroLift has recently been approved by the UK National Institute for Clinical and Health Excellence (September 2015) as effective and safe and cost-effective for use in the UK health system. This review describes the device and the procedure and the evidence base that has led to those approvals.

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Benign prostatic hyperplasia and new treatment options – a critical appraisal of the UroLift system

Transurethral resection of the prostate (TURP) is considered the 'gold standard' for the surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). However, during recent years TURP has been challenged by several minimally invasive therapies (MITs). The reasons for the development of these MITs are the need for anesthesia and the rather unchanged morbidity of TURP, including ejaculation disorders. Mechanical MITs may represent an attractive option for treating LUTS/BPO by using mechanical forces to maintain urethral patency without cutting, ablating, heating or removing prostatic tissue. The present paper provides an update on currently available mechanical devices for the treatment of LUTS/BPO including the prostatic urethral lift (PUL), the temporary implantable nitinol device, and new intraprostatic implants. It analyzes the evidence for their safety, tolerability, and efficacy in clinical practice and aims to define those subpopulations of patients who will benefit from these MITs. It is obvious that there is a wide variation in the degree of mature of the available mechanical MITs. Time and high-quality long-term studies will decide which of these therapies will be accepted by patients and urologists. At the moment, PUL is claiming its position in the armamentarium of BPO treatment.

https://journals.sagepub.com/doi/pdf/10.1177/1756287219828971

Current and emerging mechanical minimally invasive therapies for benign prostatic obstruction.

Introduction Benign prostatic hyperplasia (BPH) is an obligate disorder of the aging male prostate with close associations to other metabolic conditions of aging including obesity. Clinical manifestations of this chronic disorder increase as men age suggesting that a growing number of older men will require intervention for progressive voiding symptoms or bladder dysfunction. Materials and methods The Prostatic Urethral Lift (PUL) procedure represents a new endoscopic approach in which small permanent intraprostatic implants are positioned to correct bladder outlet obstruction without tissue destruction. An overview of the treatment modality, review of recent literature, and analysis of data in the context of cost considerations is presented. Results The mean symptom score improvement of the prospective, sham controlled, pivotal trial was 11 points, 88% greater than sham controls. Multiple studies have confirmed symptom score improvement of at least 52%. Durability has been established out to 3 years. A randomized comparison between PUL and transurethral resection of the prostate (TURP) established PUL as superior to TURP in terms of a composite BPH6 endpoint which incorporated symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation, and safety. The National Institute for Health and Care Excellence of the United Kingdom conducted an analysis that found PUL is less costly than TURP. Earlier management with PUL may even reduce overall cost for those patients managed with medication. Conclusion Current reports have demonstrated rapid voiding symptom improvement with a low risk of adverse events suggesting that this procedure represents a safe and cost effective new paradigm for the early therapy for BPH/ LUTS.

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Prostatic urethral lift: a novel approach for managing symptomatic BPH in the aging man.

Lower urinary tract symptoms (LUTS) and sexual health have common links. Medical and surgical treatments for LUTS can significantly affect various domains of sexual health including erectile function, ejaculatory function, and libido. This review summarizes recent findings. Current literature demonstrates a strong association between LUTS, sexual health, and metabolic syndrome. The role of miRNA is also being investigated. Combination medical therapy with phosphodiesterase 5 inhibitors (PDE5-I) shows promise but needs further investigation. Newer surgical therapies for benign prostatic hyperplasia (BPH) aim to preserve sexual function without sacrificing efficacy and durability. Although we are beginning to acknowledge the link between LUTS and sexual health, a better understanding of the underlying biochemistry is needed. Only then can more effective therapies be developed. Further prospective studies should focus on the long-term durability and safety of treatments for both conditions.

The Complex Relationship Between Lower Urinary Tract Symptoms and Sexual Health

Prostatic urethral lift (PUL) has been shown to be a safe, effective treatment option for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Discomfort with PUL is similar to that with rigid cystoscopy and can be tolerated with local anesthesia in an office setting. Of those who are given voiding trials, 70–80 % of subjects do not require a catheter. Subjects often quickly return to pre-operative activity level with minimal absence from work. Symptom relief can start within 2 weeks and be sustained through 2 years. Urinary flow rate improvements have been shown to be durable through 2 years. The most common adverse effects are dysuria, hematuria, pain, and urgency which are typically mild to moderate and transient. Sexual function appears to be preserved after PUL with no reported new-onset erectile dysfunction or anejaculation events. The retreatment rate is reported to be 7.5 % at 2 years.

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A Review of the Prostatic Urethral Lift for Lower Urinary Tract Symptoms: Symptom Relief, Flow Improvement, and Preservation of Sexual Function in Men With Benign Prostatic Hyperplasia

The Rezūm® System utilizing convective water vapor energy (WAVE™) has been proven to safely and effectively ablate obstructive tissue of the prostate, including the median lobe. Clinical trials have demonstrated rapid and significant relief of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) while improving quality of life scores. Moreover, durability of these beneficial results has been demonstrated through 12 months of follow-up. The most common side effects include dysuria, urgency, and hematuria, which are typically of short duration. Importantly, erectile and ejaculatory functions are preserved. This thermal therapy can be performed in an outpatient or office setting under oral sedation, prostate block, or conscious IV sedation.

An Outcomes Review of Minimally Invasive Transurethral Convective Water Vapor Energy (WAVE) Therapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Neal D. Shore

Papers

A Review of the Prostatic Urethral Lift for Lower Urinary Tract Symptoms: Symptom Relief, Flow Improvement, and Preservation of Sexual Function in Men With Benign Prostatic Hyperplasia

An Outcomes Review of Minimally Invasive Transurethral Convective Water Vapor Energy (WAVE) Therapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia