The Prostatic Urethral Lift (PUL) is recognized as a minimally invasive surgical treatment for men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Compared to traditional surgical procedures such as transurethral resection of the prostate (TURP), PUL offers advantages including preservation of sexual function, reduced need for general anesthesia, and shorter recovery time. While PUL has been widely studied in patients with moderate LUTS, its efficacy and safety in individuals with urinary retention—particularly those who are catheter-dependent—remain less well established. Given the increasing interest in expanding PUL indications to higher-risk populations, this study aims to investigate the potential risks, clinical benefits, and short-term outcomes of PUL in patients presenting with urinary retention.

We identified 22 patients with urinary retention who underwent PUL for BPH at our institution from June 2022 to March 2024. 19 patients became catheter free and 3 remain retention. Median age at the date of operation was 79 years old (73-91) and 77 years old (76-79), respectively. Median preoperative prostate volume was 70.7mL (42.3-71.6) and 67.1mL (52.5-71.6) respectively. Median length of intravesical prostatic protrusion (IPP) and median length of IPP was 9mm (0-13) and 16mm(4-30), respectively.

Median operative time was 30mins (14-50)and 37mins (36-46), respectively. Median number of used implants was 7 (3-9) and 9 (7-9), respectively. Urethral catheter was removed on post operative day 2 for all cases. 19 patients who used urethral catheter became free from urethral catheter Other than urinary retention, there were no major complications. Between catheter free groups and urinary retention group, IPP was significantly shorter for catheter group (P<0.05).

In our initial experience, the Prostatic Urethral Lift (PUL) achieved an 86.3% catheter-free rate in patients with urinary retention, with no serious perioperative complications observed. These results suggest that PUL is not only effective in restoring spontaneous voiding but also carries a favorable safety profile, even in a population that typically presents with higher surgical risk. The minimally invasive nature of this procedure makes it particularly suitable for elderly patients and those with significant comorbidities who may not tolerate more invasive surgeries such as TURP or HoLEP. However, our current findings are based on a limited number of cases and relatively short follow-up. To fully establish the role of PUL in the management of urinary retention, further research is required. Larger prospective studies with long-term follow-up are necessary to validate these results, assess durability of symptom relief, and identify predictors of treatment success and potential complications.