Urodynamic Effects of Prostatic Urethral Lift Procedure for Male Voiding Lower Urinary Tract Symptoms

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 [urethral resistance factor (URA)], Schafer grade, detrusor pressure at maximum flow [P(det)Q(max)], and detrusor pressure at bladder opening [P(det)Open]). Materials and Methods: Twenty patients (main inclusion criteria: >= 50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) >= 13, prostate volume <= 60mL, and no middle prostate lobe) were enrolled in the study and a PUL was performed. Patients underwent urodynamic investigation and filled out the IPSS and quality of life (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 45mL (range 20-59), and mean prostate-specific antigen was 2.0 mu g/L (0.2-4.4). IPSS of the 16 patients reduced significantly (from 22.20 to 14.47, p=0.000). Q(max) during pressure flow study improved significantly (from 4.5 to 7.2mL/s, p=0.001), no significant difference was found in Q(max) during free uroflowmetry. There was no significant difference found in postvoiding residual. URA decreased significantly post-treatment (from 52 to 37 cmH(2)O, p=0.000). The Schafer 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 attributable 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 lower urinary tract symptoms based on BPO. However, the mechanism how PUL leads to a remarkable symptom relief remains unclear and cannot be explained by the desobstructive mechanisms we observed.