What prostate procedure involves implanting staples?

Prostate Procedures Involving Implanted Staples

The UroLift System (prostatic urethral lift) is the only prostate procedure that involves implanting permanent staple-like devices in the prostate to treat benign prostatic hyperplasia (BPH).

UroLift System Overview

The UroLift System is a minimally invasive procedure that uses small permanent implants to hold the enlarged prostate tissue out of the way, relieving compression on the urethra without cutting, heating, or removing prostate tissue. This procedure:

• Involves placing small, permanent UroLift implants (similar to staples) that pull the obstructing prostatic lobes apart
• Creates an open channel through the prostate to reduce urinary obstruction
• Can be performed as an outpatient procedure with minimal recovery time
• Preserves sexual function by avoiding damage to surrounding tissues

Comparison to Traditional Surgical Options

Unlike traditional surgical options for BPH, the UroLift procedure:

Advantages:

• Preserves ejaculatory function (unlike TURP which has 65-70% retrograde ejaculation rates)
• Has minimal downtime (typically 1-2 days versus 2-4 weeks for TURP)
• Can be performed under local anesthesia in an office setting
• Does not require cutting, heating, or removal of prostate tissue

Limitations:

• Less effective for very large prostates (>80g)
• May not be suitable for patients with significant median lobe enlargement
• Less durable than TURP (higher reoperation rates)
• Provides less improvement in maximum flow rate compared to TURP

Patient Selection Criteria

The UroLift procedure is most appropriate for:

• Men with moderate-to-severe BPH symptoms
• Prostate size <80g
• Patients who want to preserve sexual function
• Patients who wish to avoid more invasive surgical options
• Patients who have failed or cannot tolerate medical therapy

Comparison to Other BPH Procedures

TURP (Transurethral Resection of the Prostate)

• Considered the gold standard surgical treatment 1
• Involves removing prostate tissue using electrocautery
• More effective for symptom relief but higher complication rates
• Higher risk of retrograde ejaculation (65-70%)

TUIP (Transurethral Incision of the Prostate)

• Suitable for smaller prostates (<30g) 2
• Involves making incisions in the prostate and bladder neck
• Lower risk of retrograde ejaculation than TURP
• Higher reoperation rate (18.4%) compared to TURP (7.2%) 2

Laser Procedures (HoLEP, PVP, etc.)

• Various laser technologies for vaporization or enucleation 1
• Generally less bleeding than TURP
• Requires specialized equipment and training
• No implants or staples involved

Clinical Considerations

When considering UroLift versus other procedures:

1. Prioritize sexual function preservation: If maintaining ejaculatory function is important to the patient, UroLift offers significant advantages over TURP and other ablative procedures.

2. Consider prostate size: UroLift is most effective for prostates <80g, while larger prostates may benefit more from TURP, HoLEP, or open prostatectomy.

3. Evaluate symptom severity: For severe obstructive symptoms, more definitive procedures like TURP may provide better long-term outcomes despite higher initial risks.

4. Assess comorbidities: UroLift may be safer for patients with bleeding disorders or those who cannot stop anticoagulation therapy.

The UroLift System represents an important addition to the BPH treatment armamentarium, offering a balance between efficacy and preservation of sexual function through its unique approach of implanting permanent staple-like devices rather than removing or ablating prostate tissue.