The Four‐Bladder Neck Implant Technique on Early Outcomes After Prostatic Urethral Lift: A Japanese Prospective Single‐Center Study

OBJECTIVES: Outcomes after prostatic urethral lift (PUL) may vary depending on implant position and bladder neck remodeling strategy. We evaluated the impact of bladder-neck-focused implant density using a four-bladder neck implant technique on early postoperative urinary outcomes. METHODS: In this prospective study, 220 consecutive patients undergoing PUL were analyzed. Patients were divided into a conventional technique group (n = 110) and a four-bladder neck implant technique group (n = 110). The primary outcome was postoperative transient urinary retention within 30 days after PUL. RESULTS: Baseline characteristics were generally comparable between groups. Postoperative transient urinary retention occurred significantly less frequently in the four-bladder neck implant group than in the conventional group (13.6% vs. 25.5%, p = 0.026). IPSS was significantly lower at 1 month (9.9 vs. 11.9, p = 0.009) and 3 months (9.4 vs. 11.7, p = 0.007) and Qmax was significantly higher at 1 month (14.6 vs. 12.7 mL/s, p = 0.039) and 3 months (14.7 vs. 12.8 mL/s, p = 0.034) in the four-bladder neck implant group than in the conventional group. In multivariable analysis, the four-bladder neck implant technique was independently associated with a reduced risk of postoperative urinary retention, whereas implant number was not. CONCLUSION: The four-bladder neck implant technique was associated with improved early outcomes and a lower incidence of postoperative urinary retention. Implant distribution, particularly bladder-neck-focused density, may represent a key determinant of early outcomes after PUL.