Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis

Abstract

Context: Treatment for lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH) is varied, and significant side effects, particularly concerning sexual function, affect uptake. The prostatic urethral lift (PUL) procedure is a recent addition to the armamentarium for BPH treatment, with independent reports suggesting improvement of symptoms, sexual function, and urinary flow.

Objective: We undertook a systematic review and meta-analysis of reported symptomatic, functional, and sexual outcomes following the PUL procedure.

Evidence acquisition: We performed a critical review of Medline, Embase, ScienceDirect, Cochrane Library, and Web of Science databases in May 2014 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Quality assessment was performed using a modification of the Methodological Index for Non-Randomized Studies tool. All retrospective, prospective, and controlled trials were included for analysis. Symptom scores, sexual health scores, and functional outcomes were pooled and meta-analysed using quality and random-effects models.

Evidence synthesis: Ten articles comprising six independent patient cohorts were included for analysis. Pooled estimates from between 452 and 680 patients suggested overall improvement following PUL, including symptoms (large gain; standardised mean gain range of 1.3-1.6, International Prostate Symptom Score difference of -7.2 to -8.7 points), maximum flow rate (3.8-4.0 ml/s), and quality of life (2.2-2.4 points). Sexual function was preserved with a small improvement estimated at 12 mo (standardised mean gain range of 0.3-0.4). Pooled estimates were mostly heterogeneous across study groups.

Conclusions: PUL is a well-tolerated, minimally invasive therapy for BPH that provides favourable symptom, sexual health, and functional outcomes during follow-up to 12 mo. Longer follow-up and larger randomised studies are required to further confirm these preliminary results.

Patient summary: We reviewed the early results of an innovative procedure directed towards the management of prostate enlargement. The results revealed a well-tolerated procedure that produces improvement in urinary symptoms and function while preserving sexual function.

Keywords: Benign prostatic hyperplasia; Lower urinary tract symptoms; Minimally invasive surgical therapy; Prostate; Prostatic urethral lift; Urethra; Urolift.