Predictors of durability of the prostatic urethral lift (PUL) for benign prostatic hyperplasia

Abstract

Background: There is a need to understand the predictors of prostatic urethral lift (PUL) durability to help physicians counsel patients and optimize outcomes.

Methods: A simple logistic regression analysis was performed on a pooled dataset of 331 subjects across 5 PUL controlled studies with up to 5 years follow up. Predictors of "surgical durability" (no surgical treatment for return of symptoms) and "total durability" (no surgical or medical treatment for return of symptoms) were assessed at 1- and 5-year post-procedure.

Results: Placing ?4 implants regardless of baseline prostate volume was associated with increased surgical retreatment within the first year. Through one year, more implants were protective of retreatment; for every incremental implant placed, surgical retreatment odds decreased an additional 41.2% and risk of combined surgical or medical retreatment decreased 30.2%. Higher implant density was also protective through one year; for each additional implant placed per 10cc prostate volume, surgical retreatment odds decreased incrementally by 79.0%. Up to 5 years, a higher baseline pretreatment IPSS score predicted higher rates of surgical or medical retreatment; for every one-point score increase of baseline IPSS, surgical or medical retreatment odds increased 5.2%. Baseline demographics, medical history and baseline sexual function were not predictors of surgical or total durability.

Conclusions: More implants, higher implant density, and lower baseline IPSS are all associated with decreased surgical and medical retreatment rates up to 5 years following PUL. These findings inform optimizing PUL technique, considering earlier intervention and counseling men on outcomes prior to PUL.