Prostatic urethral lift for subjects in urinary retention (PULSAR): 12-Month results of a prospective controlled trial compared with real-world outcomes

Mark Rochester; Ruth Doherty; Toby Page; Neil Barber; Rajesh Kavia; Nikesh Thiruchelvam; Steven Gange; Thomas Mueller; Gregg Eure; Peter Chin; Oliver Kayes

doi:10.1002/bco2.280

Prostatic urethral lift for subjects in urinary retention (PULSAR): 12-Month results of a prospective controlled trial compared with real-world outcomes

BJUI Compass. 2023 Sep 8;5(1):60-69. doi: 10.1002/bco2.280. eCollection 2024 Jan.

Authors

Mark Rochester¹, Ruth Doherty¹, Toby Page², Neil Barber³, Rajesh Kavia⁴, Nikesh Thiruchelvam⁵, Steven Gange⁶, Thomas Mueller⁷, Gregg Eure⁸, Peter Chin⁹, Oliver Kayes¹⁰

Affiliations

¹ Norfolk and Norwich University Hospital Norwich UK.
² Freeman Hospital Newcastle upon Tyne UK.
³ Frimley Park Hospital Frimley UK.
⁴ Northwick Park Hospital Harrow UK.
⁵ Cambridge University Hospitals NHS Foundation Trust Cambridge UK.
⁶ Summit Urology Group Murray Utah USA.
⁷ Delaware Valley Urology Voorhees New Jersey USA.
⁸ Urology of Virginia Virginia Beach Virginia USA.
⁹ South Coast Urology Wollongong New South Wales Australia.
¹⁰ Leeds Teaching Hospitals and University of Leeds Leeds UK.

Abstract

Objective: To examine the safety and efficacy of prostatic urethral lift (PUL) in acute urinary retention (AUR) patients within a controlled (PULSAR) and real-world setting (Real-World Retrospective study).

Materials and methods: PULSAR was a 12-month prospective study of PUL in AUR patients (n = 51) performed at six centres in the United Kingdom; enrolled BPH patients aged ≥50 years, with prostate volume of ≤100 cc. AUR was defined as being catheter dependent with at least one prior failed trial without catheter (TWOC) while on an alpha-blocker. RWR consisted of 3226 consecutive PUL patients across 22 international sites treated between July 2017 and March 2020; 469 of whom were in urinary retention (RWRr), that is, catheter-dependent at the time of their procedure. Symptom response, uroflow and catheter independence rates were compared between PULSAR and RWRr subjects. A logistical regression model was constructed to evaluate patient baseline and dynamic factors predicting success after the procedure.

Results: Seventy-three percent of PULSAR subjects were catheter independent and free from surgical reintervention at 12 months post-PUL. Success was associated with higher voiding efficiency during the perioperative period. Slightly higher catheter-independent rates (80%) were seen in RWRr patients; variables that influenced success included age <70 years, lower baseline prostate-specific antigen (PSA), lower baseline post-void residual (PVR) and shorter pre-procedural catheter duration. Logistic regression of the combined PULSAR and RWRr retention groups revealed that procedural age <70 years and higher bladder voiding efficiency (BVE) were associated with success.

Conclusions: Lower baseline PSA and PVR, younger age and shorter pre-procedure catheter durations drove successful outcomes in AUR patients undergoing PUL. Post-PUL voiding efficiencies may help ascertain long-term response to treatment.

Keywords: acute urinary retention; benign prostatic hypertrophy; bladder outflow obstruction; bladder voiding efficiency; prostatic urethral lift.