HOW I DO IT

• How I Do It: The prostatic urethral lift for obstructive median lobes

  Ashley S. Matt, Phillips Jason, Eure Gregg Summit Health, Bend, Oregon, USA

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  Millions of men in North America suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are managed on medical therapy. Most patients, however, report poor adherence, and yet relatively few pursue more definitive surgical solutions. The Prostatic Urethral Lift (PUL) was designed to address many of the patient-identified barriers to surgery, namely iatrogenic sexual dysfunction, incontinence, lengthy recovery and postoperative catheterization. Randomized studies and large real world multicenter and database studies have demonstrated safety and effectiveness of PUL when addressing lateral lobe disease. In recent years further technique and device development has led to the FDA approval for PUL addressing obstructive median lobes as well. At 12 months, PUL median lobe patients in a controlled trial and a large retrospective study experienced average IPSS improvement of 13.5 and 11.6 points, QoL improvement of 3.0 and 2.1 points, and Qmax improvement of 6.4 and 7.1 mL/sec, respectively. In the controlled setting, both ejaculatory and erectile function were preserved and postoperative catheterization rates, while higher than lateral lobe PUL rates, were similarly short lived with a mean duration of 1.2 days. We describe the current technique for performing PUL to address the obstructive median lobe and detail a new device, which can make it easier to alleviate obstruction due to trilobar anatomy.

  Keywords: prostatic urethral lift, UroLift, benign prostatic hyperplasia, prostate, LUTS, BPH, PUL, middle lobe, median lobe,

  Apr 2023 (Vol. 30, Issue 2 , Page 11509)
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• The pulley stitch: fixation of penile prosthetic exit tubing

  Levy A. Jason, Bhanji Yasin, Burnett L. Arthur Johns Hopkins School of Medicine Brady Urological Institute, Baltimore, Maryland, USA

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  Proximal positioning of the penile prosthesis cylinder is performed during inflatable penile prosthesis surgery. We describe a technique to secure a prosthetic cylinder during inflatable penile prosthesis implantation. Urologists performing prosthetic surgeries employ a variety of surgical techniques to achieve successful outcomes. A surgical technique that secures the prosthetic device may ultimately mitigate cylinder migration and erosion. This is a simple, cost-effective technique that can be readily incorporated into conventional corporotomy closure procedures. It proves to be a feasible technique for both running and interrupted corporotomy closures. The “pulley stitch” offers an adjunctive technique for prosthesis cylinder positioning and may also help prevent migration of prosthetic devices, and it can be incorporated with corporotomy closure.

  Keywords: inflatable penile prosthesis, corporotomy, closure, pulley stitch,

  Jun 2022 (Vol. 29, Issue 3 , Page 11182)
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• State of the art: Advanced techniques for prostatic urethral lift for the relief of prostate obstruction under local anesthesia

  Walsh Patrick Lance, MD Eisenhower Medical Center, Rancho Mirage, California, USA

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  Benign prostatic hypertrophy (BPH) affects an estimated 60% of men over the age of 50 and 90% of men over the age of 80. The prostatic urethral lift (PUL) is a safe and effective office-based procedure that is used worldwide for the treatment of BPH in men who are dissatisfied with medications due to side effects or lack of efficacy or don?t want to have a transurethral resection of the prostate due to the side effects and invasiveness of the procedure. In 2012 Barkin et al, published the standard technique for the delivery of the Urolift implant. The objective of this article is to describe the current state of the art advanced techniques for the delivery of the UroLift implant.

  Keywords: prostatic urethral lift, UroLift, benign prostatic hyperplasia, prostate, LUTS, PUL,

  Jun 2017 (Vol. 24, Issue 3 , Page 8859)
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