3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 PULoffers a safe and effective office-based treatment option that can be performedusing local anestheticwith minimal sexual side effects. Future studies continue to explore and expand the indications for PUL. The PULSAR (Prostatic Urethral Lift Subject With Acute Urinary Retention) clinical trial (NCT03194737) seeks to assess the feasibility and safety for using the PUL procedure in patients with acute urinary retention secondary to BPH. Additionally, the procedure is durable with a reported retreatment rate of 13.6% at 5 years. 41 Interestingly, this is a higher rate than the 5-year retreatment rate reported with Rezum (4.4%), 24 another office-based minimally invasive therapy for BPH. Further comparisons are listed in Table 2. Das ET AL. 8 TABLE 2. Comparison between Rezum and Urolift Water vapor thermal therapy Prostatic urethral lift Rezum Urolift Mechanism of action • Heat • Mechanical • Necrosis of prostatic lobes • Obstructing prostatic lobes using water vapor/steam held apart by small injections implants • Long term: volume reduction • Long term: tissue atrophy Procedure type* • Novel,minimally invasive surgical procedure for the treatment of BPHvia a transurethral approach Indications* • Moderate, to severe LUTS secondary to benign prostatic enlargement/ obstruction with underlying BPH • Failed medical management / Non-surgical candidates • Desires preservation of sexual function Anesthesia requirements* • Local anesthesia (sufficient), transrectal prostatic block (if required) Treatment setting/location* • Office, ambulatory surgical center, operating room (if required) Treated lobes* • Lateral or Median Procedure time* • Less than 1 hour Onset of action* • < 1 month Prostate size* • < 80 grams Post-procedural catheterization • ~100% for an average of 3.4 days • ~20% for an average of 1 day Longest reported trial data • 5 years • 5 years Randomized data • 3 months against sham control • 3 months against sham control • 24 months against TURP Improvement of symptoms • IPSS: mean 10.4 point decrease • IPSS: 8-12 point decrease • Qmax: 4.3 mL/sec increase • Qmax: 2-5 mL/sec increase Impact on sexual function • No impact on erectile function • No impact on erectile function • 3%-6% risk of developing • No impact on ejaculatory ejaculatory dysfunction dysfunction Safety and adverse events* • Transient, self-resolving within weeks • Mild to moderate symptoms, most commonly hematuria, dysuria, irritative symptoms Cost/reimbursements • Covered by some of Medicare and • Covered by all of Medicare and most commercial plans most commercial plans *refers to both Rezum and Urolift