Comparison of prostatic urethral lift (PUL) versus water vapour thermal therapy (WVTT): A focus on drug-free status and unplanned admissions.

OBJECTIVES

To compare prostatic urethral lift (PUL) and water vapour thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in a real-world setting, this study compares clinical management outcomes that are less thoroughly documented in current literature-such as drug-free status, complications and post-procedure readmission rates.

PATIENTS AND

METHODS

BPH patients (age ≥50) with prostate volumes 30-80 cc who underwent either PUL or WVTT between January 2021 and December 2024 were identified. Patients were given BPH medications (alpha-blockers and/or 5-alpha reductase inhibitors) till 3 months postoperatively. The two groups were matched using a 1:3 propensity score matching; multivariable logistic regression analyses were performed on the full unmatched cohort. The primary outcome is drug-free status, defined as the cessation of alpha-blockers and 5-alpha reductase inhibitors at 6 months post-procedure. Secondary outcomes include unplanned readmission within 30 days.

RESULTS

In total, 421 eligible patients were analysed (363 WVTT; 58 PUL). In propensity score matched analyses (174 WVTT; 58 PUL), patients were more likely to be drug-free after PUL at 6 months compared to WVTT (weighted OR: 2.62 [95% CI: 1.22-5.61], p = 0.013). The association remained significant in multivariable regression analysis (adjusted OR: 2.41 [95% CI: 1.31-4.58], p = 0.006). No statistically significant difference in 30-day readmission rates was found between the two groups in either the propensity score (p = 0.097) or multivariable analysis (p = 0.123).

CONCLUSION

In this retrospective propensity-score-matched study, PUL was associated with less BPH medication use at 6 months; readmission rates were comparable for PUL and WVTT.