Urolift is Changing How Men Live with Enlarged Prostate

May 24, 2019

BPH

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If you have an enlarged prostate, are getting up multiple times during the night to urinate, and are tired of being tired, then Urolift may be the answer for you. This relatively new procedure can be helpful for men who want an alternative to medications and other medical procedures for this prostate condition.

For some men, the medications for benign prostatic hyperplasia (BPH, another name for enlarged prostate) aren’t providing the relief from symptoms of BPH they had hoped for. A wide variety of medical procedures, both invasive and minimally invasive, are also available, such as TURP, TUNA, prostatic arterial embolization, and high-intensity focused ultrasound. Yet these treatment options are not always desirable or appropriate, and many men are searching for more alternatives.

One of the more recent kids on the block is a prostatic urethral lift (Urolift) that can be implanted during a minimally invasive procedure. Originally approved by the Food and Drug Administration (FDA) in 2013 as a permanent implant for men 50 years or older who had BPH, its use was expanded in 2018 to include men age 45 and older and those who have an obstructive median lobe of the prostate.

How the Urolift works

Unlike many other medical procedures to treat BPH, Urolift involves no surgery, no incisions, and no lasers. A local anesthetic is all that is necessary. During this in-office or outpatient procedure, a clinician passes a thin needle into the urethra. The needle delivers the tiny retractors that are placed to hold the tissue of the enlarged prostate away from the urethra. The prostate is not damaged in any way from the procedure.

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Typically men can return home the same day as the procedure, and no catheter is needed.

Patients can expect symptom relief as soon as two weeks after the procedure. The most common side effects are mild to moderate burning with urination, blood in the urine, pelvic pain, and an inability to control the urge to urinate. Most symptoms disappear within two to four weeks.

Studies of the Urolift

Results of studies of the Urolift have been promising. Here are a few of the latest findings.

In a 2018 German study, 86 men had UroLift implants, including 38 men who had severe obstruction of the urethra and would have been denied the procedure. Within one month of undergoing the procedure, 86 percent (74 men) reported significant improvements and substantial symptom relief that was still in effect at 24-month follow-up. Sexual function and ejaculation did not change or improved in these men. Eleven men (12.8%) required retreatment over two years. The authors concluded that use of UroLift was effective “even in patients with severe obstruction.”

In a 2019 German review, the authors evaluated several minimally invasive treatment options for symptoms of an enlarged prostate. They identified Urolift as being “an attractive treatment option for carefully selected patients without a middle lobe who have special interest in the rapid and smooth return to daily activity and the complete preservation of sexual function.” Both of these features are extremely important to many men who are weighing their options for treatment of BPH.

Originally the Urolift was approved for men with a prostate of less than 80 grams and no median lobes. Since then, numerous studies have been conducted including men with prostates larger than 80 grams. In one such study appearing in the Journal of Endourology in 2018, 51 men with a prostate less than 80 g and 23 with a prostate larger than 80 g underwent the Urolift procedure. Median follow-up was 144 days. The authors saw significant improvement in symptoms in both groups. One factor mentioned by the authors was them men with a prostate larger than 80 g might benefit from resection of the median lobe at the same time they under the procedure.

Bottom line

Urolift is an option for men who are experiencing symptoms of an enlarged prostate and who have no responded to medication or do not want to take it, or who do not want to undergo other types of medical procedures. Men who are considering this treatment approach are encouraged to discuss the pros and cons of the Urolift technique with their healthcare provider.

References

Magistro G et al. Novel minimally invasive treatment options for male lower urinary tract symptom. Urologe A 2019 Mar; 58(3): 254-62

MPR. FDA approves Urolift system for enlarged prostate. 2013 Sep 13

Shah BB et al. Prostatic urethral lift: does size matter? Journal of Endourology 2018 Jul; 32(7): 635-38

Sievert KD et al. Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years. World Journal of Urology 2018 Oct 3

UroLift System. What is the UroLift System?

Uro Today. FDA grants clearance of expanded indications for UroLift System. 2018 Feb 23

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