Introduction: Prior data suggests prostatic urethral lifts (PULs) may be efficacious in the management of bladder outlet obstruction (BOO) in patients who have undergone radiation for prostate cancer; however, there is limited data on the morbidity of PULs in the treatment of BOO after radiation.
Methods: In this retrospective review, patients with a history of radiotherapy who underwent bladder outlet procedures between October 2011 and September 2020 were investigated. Forms of radiotherapy included external beam radiation (EBRT), brachytherapy (BT), EBRT + BT, and proton therapy (PT). We previously demonstrated PULs significantly improve obstructive voiding symptoms and quality of life at 6 and 12 months following the procedure. In this review, we assessed the morbidity of PULs by investigating the need for additional procedures and adverse events following PULs.
Results: Ninety patients with a history of radiation underwent a bladder outlet procedure between October 2011 and September 2020. Twenty-five patients underwent PULs. Other outlet procedures following radiation included transurethral resection of the prostate (n=32), photovaporization of the prostate (n=28), transurethral incision of the prostate (n=4), and prostate laser enucleation (n=1). Of the 25 patients who underwent PULs, more than half (56%) experienced at least one adverse side effect. Incontinence was the most common adverse event (36%) and stone formation (16%) was the second most common. Eight patients (32%) required additional procedures and the average time to re-treatment after PULs was 10.8 months. All 8 patients received at least one in-office cystoscopy. Two patients chose to undergo placement of an artificial urinary sphincter due to severity of incontinence/negative impact of quality of life, 4 patients required explanation of an implant and/or laser lithotripsy due to stone formation, and 1 patient required a urethroplasty. Of the patients that required additional procedures, 2 underwent ERBT, 3 underwent BT, 1 underwent EBRT and BT, and 2 underwent PT.
Conclusions: PULs significantly improved patients’ obstructive voiding symptoms and quality of life at 6 and 12 months following the procedure; however, PULs are not without morbidity. Patients need to be counseled on adverse side effects and the likelihood of multiple additional procedures.
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