PROs favor prostatic urethral lift over water vapor ablation for BPH symptoms

Patient experience was superior with the UroLift prostatic urethral lift (PUL) versus Rezum tissue ablation with steam injection, according to early patient reported outcomes from individuals who received one of the minimally invasive surgical therapies for benign prostatic hyperplasia (BPH).^1,2

Patients completed surveys within 2 months of receiving one of the procedures. International Prostate Symptom Score (IPSS) and quality of life was significantly better with PUL versus Rezum. Treatment satisfaction was 83% with PUL versus 65% with Rezum (P = .2). There was less interference with daily activities in the PUL group versus the Rezum group, including sports interference (P = .007), entertainment interference (P = .01), and community interference (P = .04).

By day 3 following the procedure, 7% of the PUL cohort had been catheterized, compared with 55% of the Rezum arm (P = .0003). The usage rate of BPH medication post-procedure was 37% with PUL versus 91% with Rezum (P <.0001).

“The UroLift System is a game-changer for patients suffering from BPH symptoms and is supported by a robust portfolio of clinical evidence as well as a growing body of real-world evidence,” study coauthor William Schiff, MD, Urology Associates of Central California in Fresno, California, stated in a press release “Providers should be encouraged by these findings showing the UroLift System offers a positive treatment experience and rapid recovery, allowing men to return to their daily activities with minimal downtime.”

The study included 53 patients who had received either mechanical disobstruction with the UroLift PUL (n = 30) or Rezum tissue ablation (n = 23). Treatment with PUL or Rezum was the only criterion for enrollment. The study included no exclusion criteria related to prostate size, BPH medical history, symptom score at baseline, bilobar or trilobar prostatic obstruction, or retention history.

Baseline characteristics were similar between the 2 cohorts. Overall, the average age was 69 and the average prostate weight was 56 g. The questionnaires were filled out at an average of 30 days following the procedure.

At baseline, IPSS data were available for 19 patients in the PUL group and 12 patients in the Rezum group. There was not a significant difference in baseline IPSS data between the 2 arms at 16 ± 7 compared with 18 ± 6.6, respectively (P = .4). Among these patients with available data, the mean IPSS improvement after the procedure was 8 points with PUL versus 6 points with Rezum (P = .6). Further, the absolute IPSS scores for all evaluable patients were significantly better post-procedure, at 8.6 ± 5 with PUL compared with 15.6 ± 9.2 with Rezum (P = .001). Patients in the PUL arm also had a significantly better quality of life, with an IPSS QoL of 1.5 ± 1.5 versus 2.5 ± 1.9 with Rezum (P = .04).

The PUL cohort also had better results on the Male Sexual Health Questionnaire-ejaculatory dysfunction (MSHQ-EjD) assessment. MSHQ-EjD results were 12.2 ± 2.7 for PUL versus 9.2 ± 5.1 for Rezum (P = .04). “PUL patients reported the ability to ejaculate more often during sexual activity and trended toward better outcomes in volume of ejaculate,” the investigators wrote.

There was not a significant difference in MSHQ-EjD bother scores at 1.1 ± 1.4 versus 1.5 ± 1.6 in the PUL and Rezum arms, respectively (P = .4). However, the researchers observed a significant difference in scores on the Sexual Health Inventory for Men (SHIM) at 14.8 ± 8.6 versus 9.2 ± 7.2, respectively (P = .02).

“These data suggest the UroLift System treatment provides patients a superior experience with better preservation of sexual function, lower catheterization rates, less daily interference, and better overall satisfaction at one month following treatment compared to Rezum,” coauthor Ronald Tutrone, MD, Chesapeake Urology Research Associates in Baltimore, Maryland, stated in the press release. “The UroLift System is an accepted standard of care treatment for men with enlarged prostate and the PUL is recommended by the American Urologic Association BPH Treatment Guidelines.”

References

1. Teleflex Announces Publication of Early Patient Experience Data Highlighting the UroLift® System as a Superior Treatment to Rezum™ Steam Injection in Patients with Enlarged Prostate. Published online June 22, 2020. https://bit.ly/3hUi0sE. Accessed June 22, 2020.

2. Tutrone RF, Schiff W. Early patient experience following treatment with the UroLift prostatic urethral lift and Rezum steam injection. Can J Urol. 2020;27(3):10213-10219.