Prostatic urethral lift gaining on TURP as treatment choice for benign prostatic enlargement/LUTS

Urologists are embracing prostatic urethral lift as a minimally invasive treatment option for treating benign prostatic enlargement and lower urinary tract symptoms. Compared with transurethral resection of the prostate (TURP) and photo-vaporization of the prostate, prostatic urethral lift has favorable readmission rates but a higher risk of retreatment, according to a study published in The Journal of Urology.¹

Investigators analyzed a database of US men treated with endoscopic procedures for benign prostate enlargement and lower urinary tract symptoms between 2000 and 2018.

More than half of the 175,150 men were treated with TURP, nearly 27% with photo-vaporization of the prostate, and more than 10% with prostatic urethral lift.

Although only 10.8% of men had prostatic urethral lift to treat their symptoms in 2018, utilization of the treatment was up from less than 0.4% in 2014. TURP use was stable at 50.2% to 52.6% during the same period, whereas prostate photo-vaporization use fell from 36.5% in 2014 to 25.6% in 2018.

Urologists’ rapid adoption of the prostatic urethral lift (UroLift) surprised the study authors.

“Urologists tend to be early adopters of new technology. That said, how fast adoption of prostatic urethral lift has been in the urologic community was really impressive,” said study author Jonathan Shoag, MD, assistant professor, Urology Institute at University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.

TURP has well-established safety and efficacy profiles, and laser photo vaporization of the prostate has been widely used to treat benign prostatic enlargement and lower urinary tract symptoms. But adverse consequences associated with these procedures, including retrograde ejaculation, bleeding, need for general or regional anesthesia, and the potential for an overnight hospital stay, led to growing interest in less invasive therapy options, including the FDA-approved UroLift, according to the investigators.

Limiting their study to the 3 most common benign prostatic enlargement treatments, the investigators found that that overall readmission rates were 2.09% at 30 days and 5.81% at 90 days.

Readmission rates at 30 days were 2.2% for TURP, 2.1% for prostate photo-vaporization, and 1.2% for prostatic urethral lift. The 90-day comparison of readmissions was 5.7% for TURP, 6.0% for prostate photo-vaporization, and 2.9% for prostatic urethral lift.

“The principal concern regarding the efficacy for [prostatic urethral lift] is treatment durability,” the authors wrote.

They found the retreatment rate overall was 3%. But patients treated with prostatic urethral lift were almost twice as likely as those treated with TURP to be retreated by the 2-year follow up. Retreatment at the 2-year follow up was 5.2% for prostatic urethral lift, 3.2% for prostate photo-vaporization, and 2.9% post TURP.

“This reinforces that counseling men appropriately on prostatic urethral lift is important. It can minimize some of the side effects of other treatments, like ejaculatory dysfunction and decrease the need for catheterization. That said, its durability is probably lower, and it does have higher retreatment rates,” said study author Irina Jaeger, MD, assistant professor, Urology Institute at University Hospitals Cleveland Medical Center, Case Western Reserve University.

Jaeger said that she offers prostatic urethral lift to appropriate patients.

“It is a great option for patients that want to get back to normal life quickly and preserve ejaculatory function. We've seen that side effects tend to be minimal,” she said.

Prostatic urethral lift, however, is not appropriate in all benign prostatic enlargement cases, and patients need to be counseled appropriately, Jaeger said.

Reference

1. Gaffney CD, Basourakos SP, Al Hussein Al Awamlh B, et al. Adoption, safety, and retreatment rates of prostatic urethral lift for benign prostatic enlargement. J Urol. 2021;206(2):409-415. doi:10.1097/JU.0000000000001757