Men with catheter dependent urinary retention (UR) secondary to benign prostatic
hyperplasia(BPH) are particularly challenging patients to treat non-operatively, and surgical
intervention is commonly warranted. The purpose of our study was to evaluate the efficacy of
Prostatic Urethral Lift (PUL) as a surgical treatment option in men with catheter dependent UR.
Specifically we analyzed post-operative patient subject outcomes, post void residual
measurements, and success defined by catheter free rates.

This was a retrospective chart review of patients with catheter dependent UR who underwent in office PUL between 2016-2019 by one single surgeon. Of note, men were not excluded if they had prior prostatic surgical intervention. International prostatic symptom score (IPSS), quality of life (QOL) measures, and post void residuals (PVR) were recorded at baseline and at subsequent office visits at 2 week, 2 month, 6 months, 12 months, 18 months and 24 months post operatively. Catheter free rates were recorded. A paired-sample T-test was used to compare pre-and post-treatment values. A value of p<0.05 was used for statistical significance.

We identified 30 men with catheter dependent UR who had undergone PUL. 6(20.0%) men had previous interventions on their prostates. Descriptive statistics demonstrated an average age of 75.2  10.6, prostate volume of 52.7  29.9, number of implants used 5.8  0.9, pre-operative PVR of 806.1  461.4, and time from procedure to catheter removal of 2.9  2.6 days.

The catheter free rate significantly improved following intervention (p<0.05). 25 (83.3%) men remained catheter free at a mean follow up time of 7.1  6.5 months. 5 out of 30 (16.7%) men required a catheter to be replaced at a mean follow up time of 2.8  3.9 months. IPSS values improved significantly from 14.8  8.9 to 5.8  3.9 (-9.0 + 9.5). Similarly, QOL and PVR improved significantly from 3.0 1.5 to 1.2  1.1 (-1.8 + 2.0) and 744.1  333.1 to 332.3  309.2 (-411.7 + 327.4) respectively.

Catheter dependent UR remains a challenging and diverse subset of men to treat. McVarey and colleagues were able to show success with water vapor therapy in 77% of men in UR yet time to catheter independence was 29 days.  Our study confirms that PUL is a significantly effective treatment in this cohort with 83% success while catheter free in <3d. Furthermore, our series demonstrates significant improvement in catheter free rate, IPSS, QOL, and PVR suggesting PUL is an effective treatment. Further research is necessary to identify the durability of PUL in men with UR.