It is postulated that earlier intervention in BPH treatment may protect bladder health. Bladder pressures are considered the best surrogate parameter to monitor bladder function. However, longitudinal studies are lacking, and urodynamic testing is invasive and not routinely used. Penile cuff testing (PCT) is a minimally invasive urodynamic alternative that measures the cuff pressure (Pcuff.int) required to interrupt flow. This measurement may provide insight into bladder exertion during urination. This is the first study to prospectively evaluate outcomes in men with BPH before and after PUL, a minimally invasive treatment with well-studied symptom relief.

Men with symptomatic BPH and compromised Qmax were enrolled at a single site. Selection criteria was unbiased and intended to reflect real-would applications of PUL. IPSS, QoL, Qmax and PCT were assessed before and 3 months after PUL. We used the Newcastle Noninvasive Nomogram (NNN) to plot obstruction categories. PCT reports and obstruction categories were reviewed by an independent urodynamic expert.

Nine subjects age 57.4 ± 6.3 years and prostate volume 53.4 ± 17.6 cc had available paired data for IPSS, QoL, Qmax and Pcuff.int. Outcomes significantly improved after PUL at 3 months, with IPSS improvement of 17 points (Table 1). Compared to the L.I.F.T. study, subjects experienced either similar or significantly greater improvements in IPSS (p=0.03), QOL (p=0.2), and flow improvement (p=0.1). Prior to PUL, all subjects were in the obstructed range with a mean Pcuff.int of 158.8 cmH2O which decreased after PUL (-28 cmH2O, 16%, p=.07), and 4 subjects (44%) moved out of the obstructed category (Table 1). Independent review showed no substantive change in PCT results. Isovolumetric bladder pressure changes compare favorably with previously reported decreases in Pcuff.int following TURP in symptomatic men with impaired Qmax (-28 cmH2O, 20%) and a sub-cohort of obstructed men (-45 cmH2O, 29%).

In this study, PUL produces improvements in IPSS, QoL, and Qmax at 3 months post-procedure, which are similar to or better than those seen in the L.I.F.T. randomized controlled trial. Using PCT testing, we were able to validate that subjects who had previously been in the obstructed flow category were no longer obstructed after PUL. PCT testing in PUL subjects also reveals favorable results when compared to subjects who have undergone TURP.

PCT, a minimally invasive assessment of isovolumetric bladder pressure, may be an important element in BPH evaluation. Penile cuff pressure measurements indicate that PUL reduces bladder pressure during voiding, which may have favorable downstream implications on bladder health.