Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Efficacia clinica ed urodinamica del Prostatic Urethral Lift (UroLift) nel trattamento dei disturbi del basso apparato urinario da iperplasia prostatica benigna

Title: Clinical and Urodynamics Efficacy of Prostatic Urethral Lift (UroLift) in lower urinary tract symptoms by benign prostatic hyperplasia. Candidate: Dott. Antonio Nacchia Tutor: Prof. Costantino Leonardo Background Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are one of the most common bothering symptoms in the male population. Surgery is the therapeutic solution when medications fail to control LUTS due to BPH. However, surgery led to bothering side effects. Mini-invasive techniques (MIS) have been proposed, including Prostatic Urethral Lift (UroLift) but little is known about the clinical and urodynamics outcomes. The aim of our study was to evaluate the clinical and urodynamics efficacy of UroLift in patients affected by LUTS due to BPH. Material and Methods A consecutive series of patients affected by LUTS due to BPH were enrolled at Sant’ Andrea Hospital of Rome from January 2022 to May 2023. Male patients >50 years old and with prostate volume <60 ml were included in the study. Exclusion criteria were urinary infections, prostatitis, bladder lithiasis, urethral stenosis, previous transurethral resection of the prostate (TURP) or other previous surgery on the prostate, previous pelvic surgery or pelvic radiotherapy, high prostate specific antigen (PSA) values, prostate cancer, medium lobe greater than 1 cm, cardiovascular comorbidities. All patients underwent MIS with UroLift. International validated questionnaires (IPSS; MSHQ; SHIM, IIEF) were filled and urodynamics was performed by patients before and three months after UroLift. Patients' characteristics were recorded. Wilcoxon’s test was performed to evaluate efficacy before and after surgery. Differences were analysed and considered significant for P<0.05. Results Sixteen patients were enrolled with a median age of 66 (57/72) years old. UroLift procedures were performed between October 2022 to April 2023. The median implantation for a patient was three. None reported urinary incontinence or retrograde ejaculation. IPSS questionnaires showed a benefit from baseline to three months (17,9 vs 9,8; p=0,001). No significative differences were found in sexual evaluation on MSHQ (7,9 vs 9,2, p=0,203), IIEF (15,6 vs 17,1, p=0,373), and SHIM (13,7 vs 13,5, p=0,234) from baseline to three months. Maximum urinary flow (Qmax) was higher after UroLift (9,8 ml/s vs 15,6 ml/s, p=0,004). No significative differences were found in bladder wall thickness (BTW) (16,5mm vs 17mm, p=0,674) and post-voided residual (PVR) (68,7 ml vs 35 ml, p=0,140). Ten patients needed bladder catheterisation after the procedure, no other complications were reported. Nowadays, six patients perform urodynamics. Preliminary results showed benefit in Schäfer plot (from 3 to 2; p=0,03) showing a dis-obstructive effect after UroLift treatment. Conclusions UroLift is a valid alternative MIS in patients with LUTS due to BPH. It allows to preserve the sexual function and ejaculation. Preliminary results showed moderate benefit in urinary flow analysed by international validated questionnaires and urodynamics Schafer plot. Further studies should be performed to support these preliminary findings.