Prostate Surgery

Is UroLift a Good Treatment Option for Men with BPH?

Benign Prostatic Hyperplasia (BPH), is a common condition in men over the age of 50 years.

It has increased in the past 10 years because of the aging population.

This article will discuss the UroLift System as a non-invasive method to treat urinary symptoms caused by BPH.

What is BPH?

Benign Prostatic Hyperplasia (BPH) occurs when the prostate, expands to twice or even three times its regular size.

The growing prostate gland gradually presses against the urethra and restricts urinary flow.

As a result, the bladder muscle becomes stronger, thicker, and more sensitive, causing it to contract.

This results in more frequent urination, and as the urethra becomes increasingly narrowed, the urine remains in the bladder, accounting for urinary problems.

Symptoms of BPH include:

If you and your doctor decide that the UroLift treatment (is suitable, they will give you pre-treatment information. You may get a prostate examination to measure volume and the level of urethral obstruction.

How does the UroLift treatment work?

The UroLift system (Prostatic Urethral Lift Procedure) involves inserting permanent implants into your prostate through the bladder. A small telescope-like instrument is passed along the (urethra).

This instrument allows a small band, similar in design to be passed between the inner and outer surface of the prostate lobes of the prostate gland. The implants pull obstructing prostate tissue away from your urethra.

The implants integrate with the prostate within months, providing sustained symptom relief.

Generally, your Urologist treatment will be performed by your urologist. The procedure is straightforward and usually done under local anesthesia.

What are the benefits of the UroLift System treatment?

For men wanting to avoid invasive surgery, UroLift may be a good option for treating urinary symptoms.

Surgical approaches such as transurethral resection, increase the risk of side effects, including erectile dysfunction and urinary tract infections.

The UroLift System provides rapid symptom relief with improved quality of life through:

  • Reducing the risk of erectile dysfunction.

  • Reducing wound healing related complications.

  • Reducing the risk of infections.

  • Eliminating the need for post-surgery catheterization.

What are the risks of the UroLift System treatment?

The National Institute for Health and Care Excellence (NICE) recommends the UroLift system for the treatment of lower urinary tract symptoms secondary to BPH in men above 50 years with a prostate volume less than 100 cm3 (Ray et al., 2016).

Younger men or those with a bigger prostate may not benefit from UroLift treatment. This is as they may experience increased complications,

What clinical data is available about the risks of the UroLift System?

Several high-quality case series and randomized trials for UroLift system procedure have reported:

  • Urinary complications
  • Urinary tract infections
  • Inflammation of the testis following

Roehrborn and colleagues investigated the effectiveness of UroLift in a randomized, blinded trial. The trial involved 206 men with lower urinary tract symptoms secondary to BPH.

Their results showed that after 12 months, the UroLift treatment significantly reduced the American Urological Association Symptom Index (AUASI).

Consistently, patients in the UroLift group achieved and sustained an increased urinary flow rate compared to the control group.

Later follow-up studies showed that the effectiveness of UroLift System was sustained over five years.

These results show that the UroLift System is effective for lower urinary tract symptoms secondary to BPH in men above 50 years of age.

However, whether men with bigger prostates will benefit from this improvement in AUASI and urinary flow rate remains to be determined.

How safe is the UroLift System treatment?

Studies by Roehrborn and others showed that the UroLift System reported fewer adverse effects compared to controls.

Generally, the recorded adverse events were mild, resolving immediately after the procedure.

Unlike surgical approaches for treating BPH symptoms, UroLift does not cause ejaculatory or erectile dysfunctions.

UroLift is performed under local anesthesia, providing symptom relief, while preserving sexual functions.

What should you expect during and after the UroLift System treatment?

Before treatment: Your doctor will help you decide if the UroLift System is suitable. You may undergo some standard prostate examination procedures. However, you and your doctor will determine what tests are required before the actual procedure.

During the treatment: Your doctor will deliver permanent implants that reduce urethral obstruction caused by an enlarged prostate. Generally, the treatment is a minimally invasive procedure, with reduced recovery time.

UroLift treatment may be performed under local or general anesthesia. You may get pain medications to help you feel comfortable. However, you may still experience some discomfort during the procedure.

After treatment: Typically, you will be discharged the same day without a post-surgery catheter. As it’s a minimally invasive procedure, recovery time is significantly lower compared to surgical interventions.

You may experience BPH symptom relief within 2 weeks. Discuss with your doctor before returning to normal activities. You should look at out for side effects such as blood in the urine, difficult urination, and pelvic pain.

Painful or difficult urination: Patients experienced more painful urination compared to the control group. McVary et al and Roehrborn et al reported about 35% incidence of painful urination compared to 17% in the control group. Other studies repeated even higher rates, including 70% and 73% by Abad et al and Shore et al, respectively.

Haematuria (red blood cells in the urine): Two of these studies reported haematuria in 25% of patients treated with UroLift compared to less than 5% in the control group. Shore and colleagues observed haematuria in 78% of the cases, while Abad reported a 30% incidence rate.

Inflammation of the testis: These studies reported variable rates of testis inflammation (orchitis), ranging from 1.5% to 5 %.

Urinary tract infections (UTIs): Chin et al reported UTI in 12.5% of patients. Though McVary et al and Roehrborn et al reported 3% of patients with UTI, the control groups had a 2% rate.

Best treatments for enlarged prostate

There are three treatment options for your BPH.

Depending on your symptoms, you may be offered one of watchful waiting, drug therapy, or surgery.

Currently, transurethral resection of the prostate(prostate TURP) is the standard of care. However, it increases your risk of developing impaired sexual function as well as urinary tract infection.

While less invasive options like UroLift reduce your risk of complications, they still involve a certain level of risk.

Your urologist will help you decide if UroLift is suitable for you. This will depend on your prostate volume and other clinical factors.

It’s worth noting that the UroLift only treats the lower urinary tract symptoms caused by an enlarged prostate.

So, you may not benefit from UroLift System treatment if your enlarged prostate is severe.

How do you treat an enlarged prostate without surgery?

You can use natural ways to manage BPH, especially before its diagnosis. Lifestyle changes like regular physical activity, healthy diet, and natural supplements, can reduce your risk of developing BPH.

What supplements can be used to help treat an enlarged prostate?

You should talk to your doctor about taking natural supplements to help maintain a healthy prostate.

You may need supplementation if you are older than 65 years due to age-related impaired nutrient absorption.

You should consider:

Vitamin D: Its deficiency increases your risk of BPH, while increased dietary intake decreases the rate of BPH.

Studies that randomly assigned men with BPH to vitamin D supplementation or placebo reported reduced prostate volume in the vitamin D group.

Lycopene: A randomized study showed that lycopene decreased PSA levels and inhibited the progression of BPH (Schwarz et al., 2008), through reduced oxidative.

Conclusion

For some men, the UroLift can effectively relieve urinary symptoms associated with BPH. However, it does not treat the mechanisms underlying your prostate enlargement — lifestyle changes like regular physical activity, healthy diet, and natural supplements can reduce your risk of developing BPH.

Sources

  1. Abad, P.G., del Peso, A.C., Ojas, B.S., Arjona, M.F., 2013. Urolift®, a new minimally invasive treatment for patients with low urinary tract symptoms secondary to BPH. Preliminary results. Arch Esp Urol 66, 584–91.
  2. Chin, P.T., Bolton, D.M., Jack, G., Rashid, P., Thavaseelan, J., Yu, R.J., Roehrborn, C.G., Woo, H.H., 2012. Prostatic urethral lift: two-year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 79, 5–11.
  3. McVary, K.T., Gange, S.N., Shore, N.D., Bolton, D.M., Cowan, B.E., Brown, B.T., Te, A.E., Chin, P.T., Rukstalis, D.B., Roehrborn, C.G., 2014. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. The journal of sexual medicine 11, 279–287.
  4. Ray, A., Morgan, H., Wilkes, A., Carter, K., Carolan-Rees, G., 2016. The Urolift system for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a NICE medical technology guidance. Applied health economics and health policy 14, 515–526.
  5. Roehrborn, C.G., 2016. Prostatic urethral lift: a unique minimally invasive surgical treatment of male lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urologic Clinics 43, 357–369.
  6. Roehrborn, C.G., Barkin, J., Gange, S.N., Shore, N.D., Giddens, J.L., Bolton, D.M., Cowan, B.E., Cantwell, A.L., McVary, K.T., Te, A.E., 2017. Five year results of the prospective randomized controlled prostatic urethral LIFT study. The Canadian journal of urology 24, 8802–8813.
  7. Roehrborn, C.G., Gange, S.N., Shore, N.D., Giddens, J.L., Bolton, D.M., Cowan, B.E., Brown, B.T., McVary, K.T., Te, A.E., Gholami, S.S., 2013. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the LIFT Study. The Journal of urology 190, 2161–2167.
  8. Roehrborn, C.G., Rukstalis, D.B., Barkin, J., Gange, S.N., Shore, N.D., Giddens, J.L., Bolton, D.M., Cowan, B.E., Cantwell, A.L., McVary, K.T., 2015. Three year results of the prostatic urethral LIFT study. The Canadian journal of urology 22, 7772–7782.
  9. Schwarz, S., Obermuller-Jevic, U.C., Hellmis, E., Koch, W., Jacobi, G., Biesalski, H.-K., 2008. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. The Journal of nutrition 138, 49–53.
  10. Shore, N., Freedman, S., Gange, S., Moseley, W., Heron, S., Tutrone, R., Brown, T., Barkin, J., 2014. Prospective multi-center study elucidating patient experience after prostatic urethral lift. Can J Urol 21, 7094–7101.

About Our Author Dr. Chinedu Anthony Anene

Alternative Text
Dr. Chinedu Anene is a biomedical researcher, interested in the epi-genetic links between angiogenesis, cardiovascular disease, and cancer. He is interested in using bioinformatics and machine learning approaches to translate knowledge of molecular biology to disease biomarkers and novel therapeutic targets. He has expertise in preparing readily accessible reference materials.

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