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Year : 2014  |  Volume : 30  |  Issue : 2  |  Page : 235-236
 

L.I.F.T. study: Prostatic urethral lift for the treatment of LUTS associated with BPH


Department of Urology, King George Medical College, Lucknow, Uttar Pradesh, India

Date of Web Publication29-Mar-2014

Correspondence Address:
Saurabh Gupta
Department of Urology, King George Medical College, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


PMID: 24744530

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How to cite this article:
Gupta S. L.I.F.T. study: Prostatic urethral lift for the treatment of LUTS associated with BPH. Indian J Urol 2014;30:235-6

How to cite this URL:
Gupta S. L.I.F.T. study: Prostatic urethral lift for the treatment of LUTS associated with BPH. Indian J Urol [serial online] 2014 [cited 2019 Nov 15];30:235-6. Available from: http://www.indianjurol.com/text.asp?2014/30/2/235/126919



   Summary Top


Transurethral resection of the prostate, considered the surgical gold standard for benign prostatic hyperplasia (BPH), offers a 14.9 AUASI improvement, but this improvement comes with a 20% perioperative morbidity rate and long-term complications that include incontinence (3%), strictures (7%), erectile dysfunction (10%) and loss of ejaculatory function (65%). [1],[2] Medical therapy provides a modest 3.5-7.5 AUASI improvement at 1 year; however, bothersome side-effects or inadequate relief prompt 30% of men to discontinue treatment. [3] Recently, Roehrborn et al. performed a multicenter, randomized, controlled blinded study in 19 centers over three countries (USA, Canada and Australia) and named it L.I.F.T. - Luminal Improvement Following Prostatic tissue Approximation for the treatment of LUTS secondary to BPH. [4] A total of 206 men were randomized (2:1) and treated with prostatic urethral lift (n = 140) or sham control (n = 66). All subjects had no prior surgical treatment, were at least 50 years old and were required to undergo washouts of 2 weeks for α blocker, 3 months for 5 alfa reductase inhibitor and 3 days for anticoagulants. All patients had AUASI ≥ 13, QMAX ≤ 12 mL/s with a 125 mL voided volume and a 30-80 cc prostate. Patients with median lobe obstruction, retention, PVR > 250 mL, PSA > 10, active infection, cystolithiasis within 3 months and bacterial prostatitis were excluded from the study. Transprostatic adjustable Urolift implants were permanently implanted to retract obstructing lateral lobes and expand the urethral lumen. After cystoscopy, the implant delivery device was inserted into the 20 Fr sheath. Under cystoscopy, the delivery device was angled anterolaterally to compress the obstructive lobe. A 19 Ga needle, housing a monofilament with metallic tab, was then deployed through the prostate lobe. As the needle was retracted, the tab engaged the prostate capsule and the monofilament was tensioned. Finally, the urethral end-piece was attached to the monofilament, which was then cut, delivering the in situ-sized implant. Because the fibromuscular capsule is less compliant than the peri-urethral tissue, the capsular tab held firmly in place while the urethral end-piece held the lobe in its displaced position thus expanding the urethral lumen. When implanted, the urethral end-piece invaginated into the urethral wall where focal injury promoted epithelialization. The objective of the  Prostatic Urethral Lift was to create a channel through the anterior aspect of the prostatic fossa. All subjects were evaluated at 3 months. All procedures were successfully completed with no perioperative serious adverse events. Procedure time for PUL was 66.2 ± 23.8 min, while that for control was 46.8 ± 17.2 min. In North America, most of the procedures were performed under local anesthesia, while in Australia the procedure was performed under general anesthesia In the PUL group, the mean AUASI reduction was 88% greater than that in the sham control. The PUL therapeutic effects were significantly better than control with regard to Qmax, quality of life and BPHII. AUASI reduction was both clinically and statistically significant by 2 weeks, further improved to 3 months and sustained at 1 year. Two patients in the PUL group had serious adverse events, which included an overnight stay for clot retention coincident with reinitiating warfarin therapy and another patient required bladder stone removal at 12 months that was not related to urethral implant. There was no incidence of de novo sustained ejaculatory or erectile dysfunction. Fourteen implants in a total of 10 patients showed encrustation, who had part of them inadvertently delivered in the bladder.


   Comments Top


The ability to perform prostatic urethral lift under local anesthesia and the low associated morbidity (absence of ejaculatory dysfunction and incontinence) associated with this minimally invasive and rapidly acting treatment offers significant advantage in treatment of LUTS due to BPH. The significant improvement in LUTS and urine floware laudatory; however, this technique has some disadvantages. The authors have mentioned the procedure time for prostatic urethral lift to be 66.2 ± 23.8 min, which is indeed quite a long time for the patient to tolerate the procedure under local anesthesia. Intra-procedural pain, hematuria (if at all), urinary tract infection and incidence of prostatitis after the procedure still need to be elucidated. Authors have taken a washout time of 3 months for 5-alfa reductase inhibitors in eligibility criteria. It is known that, long-term intake of 5-alfa reductase inhibitors decreases the volume of prostate thus leading to improvement in LUTS. [5] Therefore, a study done on naive patients would have been more informative. Prostatic stents remain an option to treat men with benign prostatic obstruction/bladder outlet obstruction; however, stent migration remains an obstacle to their widespread use. [6] The success of intraprostatic urolift implants at 1 year is heartening, but its long-term efficiency still needs to be elucidated.

 
   References Top

1.Roehrborn CG, McConnell JD, Bary MJ. American Urological Association Guideline: Management of benign prostatic hyperplasia . American Urological Association Education and Research Inc. 2003.  Back to cited text no. 1
    
2.McVary KT, Roehrborn CG, Avins AL. American Urological Association Guideline: Management of benign prostatic hyperplasia (BPH). American Urological Association Education and Research Inc. 2010.  Back to cited text no. 2
    
3.Roehrborn CG. Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: Achievements and limitations. Rev Urol 2008;10:14-25.  Back to cited text no. 3
[PUBMED]    
4.Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, et al. Multi-center randomized controlled blinded study of the prostatic urethral lift for the treatment of LUTS associated with prostate enlargement due to BPH: The L.I.F.T. Study. J Urol 2013 ; doi: 10.1016/j.juro. 2013.05.116.  Back to cited text no. 4
    
5.Roehrborn CG. The clinical benefits of dutasteride treatment for LUTS and BPH. Rev Urol 2004;6:S22-30.  Back to cited text no. 5
[PUBMED]    
6.Vanderbrink BA, Rastinehad AR, Badlani GH. Prostatic stents for the treatment of benign prostatic hyperplasia. Curr Opin Urol 2007;17:1-6.  Back to cited text no. 6
    




 

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