Prostatic urethral lift proves superior to pharmacotherapy in alleviating symptoms of benign prostatic hyperplasia

Prostatic urethral lift (PUL) provided more substantial improvements in symptoms and quality of life compared to pharmacotherapy for most patients with benign prostatic hyperplasia (BPH) enrolled in the IMPACT trial.

PUL is a minimally invasive procedure that is used to treat lower urinary tract symptoms (LUTS) associated with BPH. During the procedure, small implants are placed into the prostate to pull the prostate tissue away from the urethra, improving urinary flow. PUL is a relatively new treatment option that has shown promise in BPH cases that do not respond to pharmacotherapy. 
IMPACT, a prospective, multicenter, randomized controlled trial, was designed to compare the efficacy and safety of two different therapies for BPH, namely alpha-blocker therapy with tamsulosin (0.4 mg daily) and the minimally invasive therapy PUL (UroLift), as well as patients’ experience with the two therapies. Participants who were initially randomized to pharmacotherapy could elect to switch to the PUL intervention after a 3-month follow-up visit.

Patient experience was evaluated with the use of the King’s Health Questionnaire, which is designed to measure improvements in physical condition, social interactions, relationships, and emotional wellbeing. The Jenkins Sleep Scale was used to assess sleep quality outcomes. Results collected through 3 months were reported at the 2025 Annual Meeting of the American Urological Association in Las Vegas, Nevada.

The final analysis included 106 participants who underwent PUL procedures. In the group that was initially randomized to alpha-blocker therapy, 42 participants were satisfied with the improvements and continued pharmacotherapy throughout the trial, while 90 others crossed over to PUL interventions after 3 months due to unsatisfactory outcomes.

At baseline, participants who were satisfied with pharmacotherapy reported that BPH symptoms had the greatest impact on the physical and social aspects of daily living (eg, household tasks, exercise, travel, social life) and that they also affected their psychological health (eg, depression, anxiety, self-esteem). Those who underwent PUL procedures reported that BPH-related symptoms had the greatest baseline impact on their relationships (eg, intimate relationships, sex life). The analysis showed that PUL procedures were associated with the greatest improvements in physical status, social interactions, relationships, and emotional experiences at 1 month and at 3 months post-treatment, while participants who were not satisfied with pharmacotherapy reported the lowest rates of improvement across all domains at the same timepoints. Participants who switched from alpha-blockers to PUL reported worse social and emotional experiences at 3 months on medication compared to those who elected to stay on pharmacotherapy, and experienced the least improvement in sleep quality at 1 month and at 3 months while taking medication. Conversely, PUL was associated with the greatest rates of improvement in sleep quality, including the ability to fall asleep, nocturnal waking, and feeling rested.

“Medical therapy fails to provide adequate patient experience and sleep quality improvements for most patients with BPH in the IMPACT trial, while improvements after PUL are consistently more robust than [with] medication,” the authors concluded. “BPH patients dissatisfied with medical therapy may experience worse quality-of-life and be offered a minimally invasive surgical therapy such as UroLift PUL.”