Impact of prostate urethral lift device on prostate magnetic resonance image: A mini-review

Benign prostatic hyperplasia (BPH) affects many men, leading to lower urinary tract symptoms (LUTS) and potential complications, including urinary retention and urinary tract infections. The standard procedure for BPH is transurethral resection of the prostate (TURP), which delivers excellent functional outcomes. However, TURP could be associated with significant morbidities, including retrograde ejaculation, urinary incontinence, or bladder neck contractures. Prostatic urethral lift (PUL) is a super-minimally invasive procedure to treat LUTS caused by BPH. It works by widening the prostatic urethra and pinning the obstructing prostate lobes to the anterolateral sides of the prostate using an implant containing 2 bars and a connecting segment of nonabsorbable suture. The advantages of PUL include minimal procedure-related sexual dysfunction, urinary incontinence, and faster recovery. Prostate cancer (PC) is one of the most common cancers in men. Recently, multiparametric-magnetic resonance imaging (mpMRI) has become increasingly utilized in the clinical evaluation of PC. Herein, we review the literature to examine how PUL affects prostate MRI images and the diagnosis of PC. As a result, the nitinol capsular tab is not visualized on MRI. However, the stainless-steel urethral end-piece of the PUL device can produce a susceptibility artifact measuring 10–15 mm. Additionally, this artifact is more prominent in diffusion-weighted imaging and apparent diffusion coefficient images compared to T2-weighted sequences. Previous studies have employed artifact reduction protocols to mitigate its impact. According to previous study, the device is unlikely to obscure a diagnosis of PC, as no cancers were identified exclusively in the posterior transition zone in their cohort of prostate MR fusion biopsies. However, small lesions located in the transition zone may still be missed. Further research is needed to investigate large-scale and long-term outcomes and prognosis of patients diagnosed with PC after undergoing PUL.