Presented by: Keng Lim Ng BSc(MED), MBBS, MS, FRCS(Urol), PhD
Frimley Health NHS Foundation Trust

Introduction

Urolift is widely accepted as treatment for men with moderate/severe LUTS secondary to BPE with excellent post op urinary flow outcomes while preserving sexual function. However in a subset of men who present with prostatic enlargement and concomitant high and tight bladderneck, urolift alone with not achieve satisfactory outcomes. Therefore, in our institution , we have modified the surgical technique to combine a mini bladder neck incision (mini BNI) with urolift and have achieved good outcomes while preserving erections and antegrade ejaculation. 

Materials

Retrospective data of mini BNI and urolift were collected from September 2019 to September 2022 in  our single institution. Following pre operative flexible cystoscopy assessment, these patients were counselled for the procedure. All cases were done under sedation in a daycase procedure room. A 6 oclock vertical mini incision at the bladder neck was done with electocautery Collins knife, followed by 4 urolift implants to achieve a wide open bladder neck and prostatic fossa. Data including IPSS, flowmetry, sexual function and patient satisfaction were recorded accordingly.

Results

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40 procedures were performed with median age of 70 years and mean prostate volume of 40mls. All patients underwent procedure under sedation and were discharged on same day. 90% o fpateitns were discharged without catheter while other 4 returned for successful TWOC 3 days later. Preop mean IPSS score reduced from 17 to 8 post operatively. Mean quality of life scores reduced from 4.7 (preop) to 2.3 (post op). Maximum flow rate improved by 60% post surgery. Post operatively, all sexually active patients described no worsening of erectile function and maintained antegrade ejaculation. No significant post op complications were recorded except for one case who had UTI treated in the community.

Conclusion

From our early experience, this modified technique of mini BNI combined with urolift is safe, effective minimally invasive treatment for subset of men with BPE with concomitant high/tight bladder neck while preserving sexual function. Further collection of data will be needed to assess the efficacy of this procedure in the long term.

Funding

No funding received for this.

Lead Authors

Rami Abuseedou, MD
Frimley Health NHS Foundation Trust

Neil Barber, MD, FRCS
Frimley Health NHS Foundation Trust