Prostatic Urethral Lift (Urolift)
Figure 1: Prostatic Urethral Lift.
What are the indications for a Prostatic Urethral Lift (Urolift)?
Indications for a Prostatic Urethral Lift (Urolift) include:
Lower urinary tract symptoms not improving with medication
Lower urinary tract symptoms where patients do not prefer to take medications or wish to avoid sexual side-effects of medications
Unable to pass urine (urinary retention)
Where patients wish to avoid sexual side-effects of a TURP / LASER prostatectomy
Patients who have significant medical problems or are on blood thinning medications precluding a long anaesthetic or TURP / LASER prostatectomy
The main benefits of a Prostatic Urethral Lift (Urolift) compared with other surgical treatments for prostate enlargement, are a short hospital stay, minimally invasive procedure and a significantly lower chance sexual side-effects such as retrograde (dry) ejaculation or erectile dysfunction (impotence).
What pre-operative work up is needed?
Your urologist will organise any necessary urine and blood tests and imaging scans at your consultation prior to your procedure.
Often a flexible cystosopy may be needed prior to this procedure, as Urolift may not be suitable for all patients depending on their prostate size or configuration.
If you take any blood thinning medication, you should discuss with your urologist if these need to be stopped before your procedure. In general, aspirin can be continued in most cases but other medications such warfarin, plavix (clopidogrel) and anticoagulants may need to be stopped temporarily.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications, any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the anaesthetic (sedation or general) before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does this procedure involve?
After an injection of antibiotics, you are given an anaesthetic. A telescope is passed into your bladder through your urethra (waterpipe). Two to four implants are placed between the inner and outer surfaces of the prostate, so that they pull the obstructing prostate lobes away from your urethra, so that it no longer blocks the outflow of urine from the bladder. The procedure usually takes 10 to 15 minutes to complete. You will be discharged when you have passed urine satisfactorily on the same day after your procedure. A catheter is not usually necessary after the procedure, but your urologist may leave one in overnight, especially if you had one before your operation.
Are there any risks or side-effects of the Urolift procedure?
Stinging when you pass urine for about a week 30-40%
Pain or discomfort in your pelvic area 10-20%
Blood in your urine for about a week 30-40%
Infection in your urine requiring antibiotics 5-10%
Temporary frequency, urgency and leakage 5-10%
Inability to pass urine (retention) needing a catheter 3-5%
Inadequate relief of your symptoms needing re-treatment 15%
Encrustation (stone formation) on the implant(s) requiring later removal 1-2%
Sexual dysfunction (dry ejaculation or impotence) 1-2%
Scarring of your urethra 1-2%
Major anaesthetic or cardiovascular problems - rare
What can I expect when I get home?
You will have some burning and bleeding and minor discomfort in the area when you pass urine over the first few days, which can be relieved by simple painkillers such as paracetamol and ibuprofen
You should be able to return to normal activities and driving after 5-7 days and strenuous work and exercise after 2 weeks if you are pain free and your GP is happy with your progress.
If you develop severe pain, significant bleeding, fevers, feel unwell or are unable to pass urine you should go to the emergency department.