Shore Neal, Freedman Sheldon, Gange Steven, Moseley William, Heron Sean, Tutrone Ron, Brown Thomas, Barkin Jack
Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA.
Can J Urol. 2014 Feb;21(1):7094-101.
The prostatic urethral Lift (PUL) procedure offers a novel treatment for men with lower urinary tract obstructive symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Most patients who seek LUTS/BPH treatment choose the intervention that offers the expectations of a significant improvement in quality of life and the least chance of short or long term morbidity. We report the results of a prospective, non-randomized study designed to further characterize the perioperative subject experience with the PUL procedure.
The PUL procedure employs permanent implants to mechanically pull the prostatic lateral lobes apart. Subjects were ≥ 50 years old with International Prostate Symptom Score (IPSS) ≥ 12, peak flow rate ≤ 12 mL, and prostate volume between 30 cc and 80 cc. Subject experience through 1 month was characterized by validated instruments designed to assess quality of recovery, work productivity, activity impairment, symptom response, quality of life, flow rate and sexual function.
Fifty-one subjects were treated without any serious adverse events. No case was abandoned or postponed due to subject discomfort. By 1 month, 86% of subjects achieved high quality recovery as measured by a score of ≥ 80 on the Quality of Recovery Visual Analog Scale. Ninety percent of subjects reported improvement in their condition and 75% of subjects would recommend the procedure to a friend. Symptom response, flow rate improvement, and sexual function preservation were comparable to published studies.
The PUL procedure was tolerated under local anesthesia, rarely required postoperative catheterization, and offered rapid LUTS relief with minimal associated morbidity. The study further allows urologists to advise patients regarding post-procedural expectations and side effects, inclusive of symptomatic benefit.
前列腺尿道悬吊术（PUL）为患有良性前列腺增生（BPH）继发下尿路梗阻症状（LUTS）的男性提供了一种新型治疗方法。大多数寻求LUTS/BPH治疗的患者会选择那种有望显著改善生活质量且短期或长期发病几率最低的干预措施。我们报告了一项前瞻性、非随机研究的结果，该研究旨在进一步描述PUL手术围手术期患者的体验。
PUL手术采用永久性植入物机械性地拉开前列腺侧叶。受试者年龄≥50岁，国际前列腺症状评分（IPSS）≥12，峰值尿流率≤12 mL，前列腺体积在30 cc至80 cc之间。通过经过验证的工具对患者术后1个月的体验进行描述，这些工具旨在评估恢复质量、工作效率、活动受限、症状反应、生活质量、尿流率和性功能。
51名受试者接受了治疗，未出现任何严重不良事件。没有因患者不适而放弃或推迟手术的情况。到1个月时，根据恢复质量视觉模拟量表评分≥80来衡量，86%的受试者实现了高质量恢复。90%的受试者报告病情有所改善，75%的受试者会向朋友推荐该手术。症状反应、尿流率改善及性功能保留情况与已发表的研究相当。
PUL手术在局部麻醉下耐受性良好，术后很少需要留置导尿管，能快速缓解LUTS，且相关发病率极低。该研究进一步使泌尿外科医生能够就术后预期和副作用（包括症状改善）向患者提供建议。
