Prostatic urethral lift (PUL) can be performed in patients at high risk for general anesthesia due to multiple comorbidities, under local anesthesia. However, the clinical efficacy of PULs in patients with multiple comorbidities remains unknown. Therefore, this study aimed to evaluate the clinical efficacy of PUL in patients with multiple comorbidities by comparing the clinical efficacy in these patients with that in healthy individuals.

We performed a retrospective observational cohort study, in which patients who underwent PUL between December 2016 and January 2019 at a single tertiary care center were categorized into two groups: healthy individuals who wanted to preserve sexual function (Group 1) and patients with high comorbidities who were at high risk for general anesthesia based on an American Society of Anesthesiologists (ASA) score of ≥3 (Group 2). The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine (PVR), International Index of Erectile Function-5 (IIEF-5), and Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD) were obtained preoperatively and compared throughout the 2-year follow-up. This study was approved by Ethical Committee of the Korea University Hospital.

Sixty-six patients were included in this study, of whom 36 were stratified as healthy individuals who underwent PUL for preserving ejaculatory function (Group 1) and 30 as having high comorbidity and underwent PUL under local anesthesia (Group 2). There were significant differences in patient age (Group 1 vs Group 2: 60.7±5.3 vs75.3±8.1, p<0.001) and comorbidities based on group classification characteristics; however, there were no differences between the groups regarding prostate volume, symptom severity, and deployed implants.

In Group 1, IPSS, IPSS quality of life (QoL), and Qmax were significantly improved and main-tained during follow-up, whereas in Group 2, improvements in these parameters were not maintained during follow-up, except for IPSS QoL (Table 1.). In both groups, there was no significant decline in ejaculatory and sexual parameters (assessed by IIEF and MSHQ scores) over the course of the 2-year and 1-year follow-up, respectively. Eleven patients (36%) in Group 2 required additional treatment for the recurrence of lower urinary tract symptoms.

Patients with multiple comorbidities had a low therapeutic effect after PUL, suggesting a high rate of treatment failure. This study suggests that comorbidity status should be considered when evaluating the expected benefits for PUL in preoperative counseling. Although PUL is a conceivable alternative in patients at a high risk for general anesthesia due to comorbidities, it should be recognized that severe and multiple comorbidities can lead to treatment failure after PUL. Future studies based on new concepts introduced in recent years should aim to determine whether other minimally invasive treatments are indeed beneficial for these patients.

Continence 2S2 (2022) 100417
DOI: 10.1016/j.cont.2022.100417