Prostatic Urethral Lift (PUL) for Treating Lower Urinary Tract Symptoms - Results of the MedLift Study

The Luminal Improvement Following Prostatic Tissue Approximation (L.I.F.T) study demonstrated the efficacy of prostatic urethral lift (PUL) to treat lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO)1. One of the exclusion criteria for L.I.F.T. was the presence of an obstructing median or middle lobe (OML). The MedLift study was a non-randomized cohort analysis assessing the efficacy of PUL to improve symptoms of BOO in 45 patients with OML. 

Other than OML status, the inclusion criteria for MedLift were identical to L.I.F.T.: ≥ 50 years of age, International Prostate Symptom Score (I-PSS) ≥ 13, and Qmax ≤ 12 ml/s. The primary endpoints were an improvement in I-PSS over baseline and incidence of post-procedure complications. Outcomes were compared to the L.I.F.T. historical cohort.

At 12-month follow-up, participants reported significant mean (SD) improvements in I-PSS, I-PSS Quality of Life, and Qmax of 13.5 (7.7), 3.0 (1.5), and 6.4 (7.4) mL/sec, respectively. There were no serious complications. Sexual and ejaculatory health scores—measured by the International Index of Erectile Function and Male Sexual Health Questionnaire for Ejaculatory Dysfunction, respectively—remained stable or improved modestly. Compared to the L.I.F.T cohort, the post-operative catheterization rate was higher. These investigators also observed that deployment of the OML implants requires mastery of a technique that may involve increased tissue manipulation.

The take-home message is that, in appropriately selected patients with LUTS secondary to BOO, PUL is effective in those with OML. However, clinicians should also note that this prospective study was non-randomized; and should recognize the need to progress through a learning curve to acquire the necessary technical skills to place the OML implants.

Written by: J. Kellogg Parsons, MD, MHS, a board-certified urologist and Professor of Urology who specializes in treating prostate cancer, benign prostatic hyperplasia (BPH), bladder cancer, and kidney cancer. Dr. Parsons currently serves as a consulting editor for European Urology and European Urology Focus and is an associate editor for Prostate Cancer and Prostatic Diseases.

1. Roehrborn CGet al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol 2013 Dec;190(6):2161-7. doi: 10.1016/j.juro.2013.05.116

Read the Full-Text Article: Prostatic Urethral Lift (PUL) for Obstructive Median Lobes: 12 Month Results of the MedLift Study
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