NICE guidance - insertion of prostatic urethral lift implants to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia

NICE have suggested that '...current evidence on the efficacy and safety of insertion of prostatic urethral lift (PUL) implants to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia is adequate to support the use of this procedure..'

• aim of insertion of prostatic urethral lift implants for lower urinary tract symptoms secondary to benign prostatic hyperplasia is to widen the lumen of the urethra by retracting the enlarged prostate lobes
  • procedure is designed to cause less tissue injury than surgical resection or thermal ablation, and it is claimed to reduce the risk of complications such as sexual dysfunction and incontinence
    
    
• procedure is designed to cause less tissue injury than surgical resection or thermal ablation
  
  
• undertaken transurethrally with the patient under local or general anaesthesia
  • pre-loaded delivery device is passed through a rigid sheath under cystoscopic visualisation
  • delivery device is used to compress one lateral lobe of the prostate in an anterolateral direction towards the prostatic capsule
  • a needle is then advanced through the lobe and capsule, and a monofilament implant with 2 end pieces is deployed
  • one end of the implant is anchored in the urethra and the other on the outer surface of the prostatic capsule, retracting the prostatic lobe away from the urethral lumen. Multiple implants are usually inserted during the same procedure

Possible adverse effects:

• urinary tract infections (within 3 months after the procedure)
  • were reported in 3% (4/140) of patients treated by PUL and 2% (1/66) of patients treated by a sham procedure in the RCT of 206 patients 1 (level of significance not reported) . Urinary tract infections were reported in 7 patients in the case series of 64 patients (all infections were successfully treated with antibiotics)
• orchitis
  • reported in 3 patients in a case series of 102 patients
• symptoms of prostatitis
  • symptoms of prostatitis (penile and perineal discomfort, pain on erection and ejaculation) were reported in 1 patient in the case series of 64 patients (the condition was treated with antibiotics)
• urinary retention
  • urinary retention (within 30 days of the procedure) was reported in 16% (3/19) of patients in the case series
• haematuria
  • haematuria (within 3 months after the procedure) was reported in 26 % (36/140) of patients treated by PUL and 5% (3/66) of patients treated by a sham procedure a RCT of 206 patients
• transient incontinence
  • was reported in 8%(5/64) patients in a case series
• incomplete voiding
  • reported within 30 days of the procedure in 1 patient in the case series of 19 patients
• erectile dysfunction 
  • reported within 30 days of the procedure in 11% (2/19) of patients in the case series of 19 patients. This spontaneously resolved after 23 days in 1 patient and 127 days in the other patient

For detailed information then consult full guidance (1).

Reference:

• NICE (January 2014).Insertion of prostatic urethral lift implants to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia