What I have learnt from my experience of the UroLift procedure

Mrs Maya Harris

By Maya Harris, consultant urologist, Birmingham Prostate Clinic

I first came across this new procedure in America four years ago, whilst attending a meeting of the American Urological Association. I was surprised by the simplicity and elegance of the idea that rather than removing the prostate tissue, it could be retracted to open the passage for urine through the prostate. I learned and introduced the technique as soon as it has became available in England and have carried out what is currently the highest volume of the procedures in West Midlands.

One might ask, what is so special about the procedure? Over the years, I have done many prostate operations for benign prostatic hyperplasia. With the right patient selection, the results are excellent, however, frequently at a price. After the old style TURP, many patients complained that they found the catheter, required for bladder drainage post-operatively, very uncomfortable and recovery lasts several weeks or months usually. The patients also run risks of significant bleeding, scarring and a very small, but highly significant risk of incontinence. The procedure also usually affects sexual function and that fact deters many men from seeking treatment for their condition. Urolift, as opposed to TURP and Greenlight laser prostatectomy, is a day case procedure and does not usually require a catheter postoperatively. Men can return to the full activity within a week and I found that it is very important for many with busy jobs. The trials of Urolift have proven that sexual function is completely preserved, including ejaculation, so men do not need to sacrifice this aspect of their lives.

Why don’t I do Urolift for all of my patients? Due to the nature of the procedure, it won’t be suitable for all patients requiring prostatic surgery. Your prostate has to be right size and shape, meaning there should be no significant middle lobe and smaller than 100 ml, for implants to work. I usually personally assess these factors during a local anaesthetic bladder examination. Also, preserved bladder function is important and if there is significant urine retention, requiring catheter, I would recommend laser prostatectomy (GreenLight laser surgery), as the outcomes are also excellent and it is much less invasive compared to the traditional TURP.

In addition, the trials have shown that the outcome of Urolift might not be as durable as for TURP and GreenLight laser prostatectomy, with about 10 per cent patients requiring further surgery. However, half of those have further Urolift implants, showing that still men prefer a procedure which is least invasive.

Overall, my experience of Urolift has been very positive and I would recommend as an option to any man, considering surgery to address their urinary symptoms.