Three year results of the prostatic urethral L.I.F.T. study

available at http://www.ncbi.nlm.nih.gov/pubmed/24642149 Editorial Comment: Urethral bulking injection has long been used for the treatment of stress urinary incontinence in women. A variety of materials have been used through the years, including autologous fat, glutaraldehyde cross-linked bovine collagen, polytetrafluorethylene, carbon microspheres, calcium hydroxyapatite and various polymers. Each product has advantages and disadvantages, and many are no longer commercially available. These authors report the efficacy and safety of a polyacrylamide hydrogel material in a group of 20 women treated for stress incontinence. Results at 24 months showed good improvement in overall continence with a decrease in pad use and reduction in leakage episodes. Injection of bulking agents may be a useful treatment in elderly women who may not be surgical candidates for more invasive procedures such as sling surgeries. Tomas L. Griebling, MD, MPH Suggested Reading Faerber GJ: Endoscopic collagen injection therapy in elderly women with type I stress urinary incontinence. J Urol 1996; 155: 512. Benign Prostatic Hyperplasia Re: Three Year Results of the Prostatic Urethral L.I.F.T. Study C. G. Roehrborn, D. B. Rukstalis, J. Barkin, S. N. Gange, N. D. Shore, J. L. Giddens, D. M. Bolton, B. E. Cowan, A. L. Cantwell, K. T. McVary, A. E. Te, S. S. Gholami, W. G. Moseley, P. T. Chin, W. T. Dowling, S. J. Freedman, P. F. Incze, K. S. Coffield, F. D. Borges and P. Rashid University of Texas Southwestern Medical Center, Dallas, Texas Can J Urol 2015; 22: 7772e7782. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26068624available at http://www.ncbi.nlm.nih.gov/pubmed/26068624 BENIGN PROSTATIC HYPERPLASIA 137 Editorial Comment: There is a renaissance occurring in minimally invasive therapies for males with lower urinary tract symptoms. The technique with the most data as well as regulatory approval is the prostatic urethral lift (PUL, UroLift ). The 3-year L.I.F.T. (Luminal Improvement following Prostatic Tissue approximation for the treatment of LUTS secondary to BPH) study reported herein is the latest data set demonstrating treatment durability. There are a number of uplifting observations and some caveats as well. Of the original 140 men who underwent PUL 93 (66.4%) were available for analysis per protocol, which means that treatment failures are not included in the durability data sets. The good news is that symptom improvement was noted, albeit with degradation ( 10.61 at 1 year and 8.83 at 3 years). Moreover, sexual function, especially regarding ejaculation, was preserved. However, what happened to the other 47 men? Some were lost to followup, censored or removed from the analysis for various reasons, and 15 (10.7%) underwent either electrical or laser transurethral prostatectomy or repeat PUL. Of concern is that 10 patients (7.1%) underwent removal of implants, and encrustation was most likely due to improper placement of PUL with exposure to the interior of the bladder neck. There are a number of important issues to be raised about this and any future technology. The data reported on PUL warrant its use in the urological community. It is troubling that many insurance carriers, including Medicare, in some states do not offer reimbursement for a Food and Drug Administration approved procedure. That is a disservice to some men who may benefit from this nonsurgical procedure, which can often be performed in the urology office. Let the urological community and our patients determine if PUL is a viable long-term procedure for men with lower urinary tract symptoms. Let the chips fall where they may as the data mature and evolve in the hands of those less experienced with and/or dedicated to the procedure and/or as reimbursement decreases. While it is reasonable to question the long-term viability of a treatment that yields a durable response in only two-thirds of patients, it is unreasonable that lack of insurance reimbursement of a Food and Drug Administration approved device is the reason patients cannot be treated with PUL. Hopefully reasonable decisions in the future will prevail. Steven A. Kaplan, MD