The “swipe” technique for prostatic urethral lift: a comparative analysis of 200 patients in a prospective cohort

The Prostatic Urethral Lift (PUL) procedure is an established minimally invasive surgical therapy for benign prostatic hyperplasia. However, clinical outcomes can be inconsistent, potentially due to variations in surgical technique. We introduce the 'Swipe technique'—a novel method employing an anterior-to-lateral swiping motion—designed to improve anterior channel patency. This study compares its outcomes to conventional PUL. In a prospective registry, 200 consecutive patients undergoing PUL were analyzed. Procedures performed before July 2024 utilized the conventional technique (n=108), while those from July 2024 onward employed the Swipe technique (n=92). The primary outcome was the International Prostate Symptom Score (IPSS) at three months. Secondary outcomes included IPSS-Quality of Life (IPSS-QoL), maximum flow rate (Qmax), recurrent retention, and 30-day readmissions. Baseline characteristics, including prostate volume, preoperative catheter dependence and baseline IPSS, were comparable between groups. The Swipe technique demonstrated superior three-month IPSS (6.1 vs. 7.9 points; p=0.017) and IPSS-QoL (2.3 vs. 2.6 points; p=0.006). Recurrent retention rates were significantly lower with the Swipe technique (1.1% vs. 11.1%; p=0.004). Qmax and same-day catheter-free rates (over 80% in both groups) were comparable. No severe complications (Clavien-Dindo ≥III) occurred in either group. We reported a novel, effective, and reproducible technique for prostatic urethral lift (PUL) – the Swipe technique. The Swipe technique showed better three-month IPSS, three-month IPSS-QoL, and recurrent retention rates compared to the conventional technique. Further research into the technical aspects of PUL is required to standardize the technique.