What is UroLift (Urethral Lift) for benign prostatic hyperplasia (BPH)?

What is UroLift (Prostatic Urethral Lift)?

UroLift is a minimally invasive mechanical procedure that uses permanent implants to compress and retract obstructing lateral prostatic lobes away from the urethra, creating an open channel for urine flow without cutting, heating, or removing prostate tissue. 1

Mechanism of Action

• The procedure involves placing small permanent implants (typically 2-8 clips per patient) that physically pull the enlarged lateral lobes of the prostate away from the urethra, mechanically opening the urinary channel. 2, 3
• Unlike ablative procedures (TURP, laser), UroLift does not destroy tissue—it simply repositions it, which is why sexual function is preserved. 4, 5

Patient Selection Criteria

UroLift should only be offered to highly selected patients who meet ALL of the following criteria: 1

• Prostate volume <70-80g (the 2023 European guidelines specify <70ml, while AUA guidelines specify <80g) 1
• Verified absence of an obstructive middle lobe (this is an absolute contraindication as the device cannot address median lobe obstruction) 1, 3
• Lateral lobe enlargement pattern only 3
• Patients prioritizing preservation of ejaculatory and erectile function 1

Efficacy Compared to TURP

Patients must be counseled that UroLift provides significantly less symptom improvement and lower urinary flow rates compared to TURP, which remains the gold standard. 1

• In the BPH6 comparative trial, only 73% of UroLift patients achieved the treatment response goal (≥30% IPSS reduction) at 12 months versus 91% with TURP (p=0.05). 1
• At 24 months, TURP patients had IPSS scores 6.1 points better than UroLift patients. 1
• Peak urinary flow rates (Qmax) were significantly lower with UroLift at all follow-up intervals compared to TURP. 1

Sexual Function Preservation

The primary advantage of UroLift is complete preservation of erectile and ejaculatory function, with no cases of de novo erectile dysfunction or ejaculatory dysfunction reported. 1

• Ejaculatory function scores (measured by Male Sexual Health Questionnaire for Ejaculatory Dysfunction) significantly favored UroLift over TURP. 1
• Erectile function measures were similar between UroLift and TURP at all time points. 1
• This makes UroLift particularly appropriate for sexually active men who prioritize maintaining ejaculatory function. 1, 5

Retreatment Rates and Durability

Patients must be informed that evidence regarding long-term efficacy and retreatment rates remains poorly defined. 1

• The 5-year retreatment rate was 13.6% in published studies. 1
• Failure rates requiring other interventions range from 7-22% at 2 years, with one study showing 17.18% failure at 2 years. 2
• The 2019 AUA guideline amendment specifically emphasizes that "evidence of efficacy and retreatment rates are poorly defined." 1

Procedural Details and Recovery

UroLift can be performed as an outpatient procedure under local, regional, or general anesthesia with minimal catheterization time. 4, 2

• In one series, 64% had general anesthesia while 36% used regional/local anesthesia or entonox. 2
• Post-procedure catheterization was needed in 53% of patients, with most (53%) achieving successful voiding within 7 days. 2
• Operative time and hospitalization are significantly reduced compared to TURP. 4

Adverse Events

Common complications are generally mild (Clavien-Dindo grade 1) and self-limiting: 2, 5

• Dysuria (19.6%) is the most common complaint and resolves spontaneously. 2
• Acute urinary retention requiring short-term catheterization occurs in approximately 7.8% of cases. 2
• Urinary tract infections occur in approximately 6.25% of cases. 2
• Hematuria requiring transfusion is rare (1.56%). 2
• No cases of urinary incontinence or sexual dysfunction have been reported. 1, 4, 5

Clinical Positioning

According to the 2023 European Association of Urology guidelines, UroLift should be offered (strong recommendation) to men with LUTS interested in preserving ejaculatory function, with prostate volume <70ml and no middle lobe. 1

The 2018-2019 AUA guidelines provide a moderate recommendation for considering UroLift, but emphasize it is a conditional option with less efficacy than TURP. 1

Key Limitations and Pitfalls

• Do not offer UroLift to patients with median lobe obstruction—the device cannot address this anatomy and will fail. 1, 3
• Do not offer UroLift to patients with prostates >70-80g—efficacy has not been established in larger glands. 1
• Permanent implants remain in the prostatic urethra indefinitely, which may complicate future prostate procedures or imaging. 3
• The procedure is unsuitable for central zone obstruction—only lateral lobe patterns are appropriate. 3