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Prostatic Urethral Lift Procedure (Urolift® System)

The Urolift is a relatively new surgical procedure designed to treat men who have benign prostatic enlargement (BPE).  It is suitable for those patients where medication has been tried but has not been tolerated, or where it has not been effective.

Typically those patients who respond well to this surgery are those whose prostate is not very enlarged.  It may well suit the younger man who wishes to minimise the sexual side effects experienced from taking medication, and those men who find the side effects of conventional surgery unacceptable.

The Procedure

A small telescope-like instrument is passed along the waterpipe (urethra).  This instrument allows a small band, similar in design to a treasury tag, to be passed between the inner and outer surface of the lobe of the prostate gland.  This small implant retracts part of the lobe of the prostate, relieving the pressure/obstruction on the urethra, and obviating the need for any cutting or burning of tissue.  The number of bands put in place depends on the size and shape of the prostate.  After the surgery, most men are able to pass urine without the need for a catheter in situ post-operatively.

The surgery can be carried out either under sedation, or under a general anaesthetic, so that the patient is asleep throughout the procedure.  The choice of sedation or general anaesthetic will be determined following discussion with the surgeon and anaesthetist.

In general, patients will go home the same day the surgery is performed.

Benefits of Urolift

In most cases there is immediate improvement in the ability to pass urine, with the risks of sexual dysfunction being extremely small.

Suitability of Urolift

It is vitally important that the consultant carries out a full individual examination to assess current voiding function, shape and size of the prostate, sexual function, and the necessary evaluation for prostate cancer.  Patient expectations following surgery must be considered, as should other types of treatment available for BPE.

Side Effects of the Urolift

These are some of the more common side effects that may occur following the procedure:

  • Sensitivity when passing urine
  • Urinary frequency
  • Strong urge to pass urine at times
  • Minimal bleeding
  • General pelvic discomfort/pain
  • Urinary leakage (relatively uncommon) but linked to urge
  • Urinary tract infection (occurs in approximately 5% patients)
  • Side effects from the anaesthetic

Post Surgery Advice (first 2-4 weeks)

  • Avoid heavy lifting and straining
  • Light exercise is okay
  • Avoid getting constipated
  • Try not to go to the toilet ‘just in case’ so that the bladder learns to behave more ‘normally’
  • Avoid long journeys or prolonged periods of sitting
  • Avoid sexual activities
  • Maintain a good fluid input of between 1.5-2 litres per day
  • Drink steadily throughout the day
  • Don’t drink too much tea or coffee (caffeinated drinks), fizzy drinks, or alcohol, as these may irritate the bladder
  • Have a couple of weeks off work
  • Avoid driving unless absolutely necessary, and definitely no driving in the first 24 hours following the surgery

Available Evidence

  • Approval by NICE, January 2014
  • In men treated with Urolift, 50% showed improvement in flow rate (twice that of drugs but less than after TURP or HoLEP)
  • 50% improvement of reported symptoms (up to 2-3 times better than drugs, but less than TURP or HoLEP)
  • No sexual dysfunction (always some degree of dysfunction following other surgeries)

As with any surgery, it is vitally important to discuss the operation, benefits, pitfalls, side effects, long-term effects, and personal expectations in full with the consultant.  This surgery is not suitable for every man with BPE.  More information can be found at www.urolift.co.uk