Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is a common complaint Urologists encounter in the office setting. There have been various surgical solutions to this problem, including transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP). As with many bladder outlet obstruction surgeries, subsets of these patients develop LUTS after some time has passed and require retreatment. With the advent of the prostatic urethral lift (PUL), these patients can undergo another minimally invasive procedure that demonstrates a strong five-year durability with minimal side effects. There are currently no studies demonstrating the efficacy of using PUL in patients with previous surgical treatments for the prostate. This abstract aims to study the efficacy of using PUL on patients who have previously had a TUNA and/or TURP.

20 men who were treated with PUL after previous surgical interventions for BPH including TUNA and TURP were retrospectively identified. Eleven men had a previous TUNA, six had a previous TURP, and two had both a TUNA followed by a TURP prior to undergoing a PUL. All PUL were performed in the office by a single surgeon. International prostatic symptom score (IPSS), quality of life (QOL), and post void residuals (PVR) were recorded at baseline and at subsequent office visits. A paired-sample T-test was used to compare pre- and post-treatment values. A p-value <0.05 was used for statistical significance.

The patient cohort was comprised of an average age of 76.3 ± 9.5, prostate volume of 40.1 ± 21.3, number of implants used 4.8 ± 1.2, and preoperative PVR of 229.7 ± 256.5. IPSS values for men undergoing PUL following TUNA, TURP, or both improved significantly from 17.1 ± 7.3 to 7.1 ± 6.5 (-5.9 ± -14.2). Similarly, QOL and PVR improved significantly from 4.3 ± 1.1 to 1.9 ± 1.4 (-1.6 ± -3.2) and 206.6 ± 219.5 to 24.8 ± 26.3 (-55.9 ± -307.8), respectively. Similar significant improvements in IPSS, QOL, and PVR were seen in the TUNA subgroup analysis as well for QOL in the TURP subgroup. Improvement was seen in IPSS and PVR in the TURP subgroup, but it was not significant.

Patients after undergoing the PUL had a 58% decrease in IPSS, 55% improvement in QOL, and 88% decrease in their PVR. While TURP subgroup was not statistically significant, we expect that a larger sample size could indeed show a statistical significance in IPSS as well as PVR.

PUL is a feasible and minimally invasive option for patients who present in the office with LUTS after having already been through a TUNA and/or TURP. Further research is required to determine the long-term durability of PUL in this subset of patients.