What is UroLift (Prostatic Urethral Lift)

From the Guidelines

UroLift is a minimally invasive procedure used to treat benign prostatic hyperplasia (BPH) by placing small implants to hold the enlarged prostate tissue away from the urethra, relieving pressure and allowing urine to flow more freely, and is recommended for men with LUTS interested in preserving ejaculatory function, with prostate volume <70 ml and no middle lobe. The procedure is typically performed under local anesthesia in an outpatient setting, taking about 30-60 minutes to complete 1. Patients usually experience rapid symptom relief, often within two weeks, with minimal downtime compared to traditional surgical options. Most men can return to normal activities within a few days and don't require a catheter after the procedure.

Key Points

• UroLift is a non-ablative technique that preserves sexual function, unlike some other BPH treatments that may cause ejaculatory or erectile dysfunction 1.
• The implants are permanent, but the procedure doesn't prevent future treatment options if needed.
• Side effects are generally mild and temporary, including blood in urine, burning during urination, urgency, or pelvic discomfort.
• UroLift works best for men with moderately enlarged prostates, and the latest guidelines recommend it as an option for patients with LUTS interested in preserving ejaculatory function, with prostate volume <70 ml and no middle lobe 1.

Considerations

• The European Association of Urology guidelines recommend offering prostatic urethral lift (Urolift) to men with LUTS interested in preserving ejaculatory function, with prostate volume <70 ml and no middle lobe 1.
• The American Urological Association guideline amendment 2019 suggests considering PUL as an option for patients with LUTS/BPH provided prostate volume <80g and verified absence of an obstructive middle lobe, but notes that symptom reduction and flow rate improvement is less significant compared to TURP 1.

From the Research

Definition and Purpose of UroLift

• UroLift, also known as prostatic urethral lift, is a minimally invasive surgical therapy for the management of benign prostatic hyperplasia (BPH) 2, 3, 4, 5, 6.
• The procedure involves the mechanical manipulation of the prostate tissue to create a channel for the outflow of urine, relieving symptoms of urinary outflow obstruction without cutting or removing tissue 4, 5.

Mechanism and Technique

• The UroLift system implants are used to pull excess prostatic tissue away from the urethra, allowing for improved urine flow 4, 5.
• The procedure can be performed under local anesthesia, and patients can typically return home the same day 5, 6.
• The technique involves the placement of UroLift implants transurethrally under cystoscopic visualization, separating the encroaching prostatic lobes 5.

Efficacy and Outcomes

• Studies have shown that UroLift improves symptoms of BPH, including lower urinary tract symptoms (LUTS), and quality of life (QoL) scores 2, 3, 4, 5.
• The procedure has been shown to be effective in relieving symptoms and improving voiding flow, with significant improvements in IPSS, QOL, and maximum flow rate (Qmax) 3, 5.
• UroLift has also been shown to have a low complication profile, with minimal adverse effects on sexual function, including ejaculatory and erectile function 2, 5, 6.

Comparison to Other Treatments

• UroLift has been compared to other treatments for BPH, including transurethral resection of the prostate (TURP) and Rezum, with mixed results 2, 4.
• UroLift appears to be a desirable option for patients who wish to preserve sexual function or who are not suitable for invasive surgery 2, 6.
• The economic evaluation of UroLift has estimated that it creates a saving compared to TURP and other treatments, making it a cost-effective option 4.