A new, less-invasive surgical system called UroLift® from Neotract is designed to treat benign prostate enlargement or hyperplasia
(BPH) without incisions to the urethra. To date, the new approach is showing
excellent results in preserving male sexual function, which traditionally
has been a significant problem with trying to surgically treat BPH.
I performed the first UroLift implant in Orange County, Calif., in November
2014. Since then, I have done more than 100 UroLift implants and couldn’t
be more pleased with the clinical outcomes.
BPH is a common condition that makes urination difficult for more than
500 million aging men worldwide. One in four men experience symptoms of
an enlarged prostate by the age of 55, and that rate increases to 90 percent
of men over the age of 70. BPH is associated with a range of chronic lower
urinary tract symptoms, such as hesitancy or pain when emptying the bladder,
weak flow of urine, and sudden, frequent urges to urinate. Men with these
symptoms can experience a decreased quality of life: they may become less
productive, sleep poorly or become depressed.
Medication is often the first-line therapy, but relief can be inadequate
and temporary. Side effects can include sexual dysfunction, dizziness
and headaches, prompting many patients to quit using the prescription
medication. For these patients, the classic alternative is surgery that
cuts or heats prostate tissue to open the narrowed urethra. Although the
surgery is effective, patients have to endure a difficult period of irritative
voiding symptoms and catheterization before they get relief.
Even the “gold standard” surgery, TURP (transurethral resection
of the prostate), can leave patients with permanent side effects such
as urinary incontinence, erectile dysfunction (ED) and, very commonly,
retrograde ejaculation (dry orgasm).
In contrast, the UroLift system is designed to open the urethra directly
without applying incisions, surgical resection, or thermal injury to the
prostate, and without the risk of sexual dysfunction.
The UroLift® device gently compresses an enlarged prostate to allow
urine to flow freely again through the urethra. Unlike other BPH surgical
treatments, UroLift preserves urinary continence and sexual function in
men with BPH.
UroLift gently compresses the prostate and holds the prostate lobes open
with small, permanent implants (like tiny metal staples), opening the
urethra while leaving the prostate intact. This allows urine to flow normally again.
UroLift is an outpatient surgical procedure approved by the FDA in the
United States. The procedure usually takes 15 to 20 minutes to complete.
It typically is done on an outpatient basis, though it can be done in
a physician’s office if the patient tolerates cystoscopy well.
A key benefit of UroLift is there is no chance of incontinence with this
procedure, as with other procedures on the prostate. That’s a significant
point because when the vast majority of men hear “prostate surgery,”
they immediately associate it with a significant likelihood of urinary
Adverse reactions associated with the UroLift treatment system are comparable
to other minimally invasive surgical therapies as well as standard cystoscopy.
The most common adverse events reported during clinical trials included
pain or burning with urination, blood in the urine, pelvic pain, urgent
need to urinate, and the inability to control urine because of an urgent
need to urinate. Most symptoms were mild to moderate in severity and resolved
within two to four weeks after the procedure.
In a two-year randomized controlled study of UroLift in 206 people, which
was published in Urology Practice (an official journal of the American
Urological Association), symptoms, quality of life, and urinary flow improved
rapidly and remained durable to two years, with only 10.7 percent of the
men who had the UroLift system needing additional BPH procedures. These
study results have now held out to the three-year interval.
Treated men returned to normal activity within eight days and showed significant
improvement in symptoms in two weeks. While urinary symptoms were effectively
treated, not a single patient lost ejaculatory or erectile function as
a result of the treatment. By comparison, 90 percent of men undergoing
the standard surgery (TURP) lose the ability to ejaculate.
I encourage men with BPH to discuss male orgasmic dysfunction with their
doctor prior to treatment. Many men with BPH are good candidates for UroLift
therapy, and they should not hesitate to ask for a thorough evaluation
to ensure that they are offered the best treatment options.
James P. Meaglia, MD, is a board-certified urologist at Mission Hospital.