What is a Urolift?
How does a Urolift work?
One of the main reasons that guys have trouble peeing is that the flow of urine from the bladder is blocked. Instead of removing the prostate tissue as is done with a TURP (transurethral resection of the prostate), the Urolift procedure puts in sutures or implants to pull open the part of the urethra that goes through the prostate. It is this more open channel that makes urination much much easier.
How is the procedure done?
For my patients, I can simply do this procedure in the office. When a guy comes to the office, I’ll have them take a couple pain medications as well as antibiotics. For some men, they will just take a valium pill to calm them down. For others (with an extra charge) there is something called Pro-Nox. Pro-Nox is like the happy gas, or nitrous gas, that is similar to what you can get at the dentist’s office. It has a nice feature in that it can really help calm you down but also wears off pretty quickly meaning that the medicine isn’t in your system too long.
After this, I’ll put numbing jelly into the urethra and keep this there for 20 minutes. So at this point, you will just lie down on the table in the procedure room and let the anesthetic medicine do its thing and numb up the urine channel.
Once the tissues are all numbed up, I’ll start the procedure. I put your legs up in stirrups and clean the genitalia. So for this part, you are lying on the table and your legs will be bent and spread out. This gives me access to the penis and lets me get the procedure started. The first part of the procedure is looking in with a camera (cystoscope). This confirms the anatomy of the urethra and gives me a sense of how many implants are needed. Through this camera, I connect the Urolift implanting device. It is the Urolift device that lets me place one suture at a time. The amount of implants needed varies depending on the prostate size.
Let’s explain this is more detail. Once I have connect the Urolift device to my scope, I will locate the part of the urethra in the prostate where I want to put the implant. I’ll then push down on the this part of the prostate and release the implant. There’s two parts to this step. The first part is having the implant go through the prostate and have the metal part placed on the outside (or lateral) part of the prostate. The second part is cutting the suture so that the part of the implant that rests on the inside of the prostate can be released and allow the implant to be cinched down.
This process takes 5-10 seconds. After I have placed the implant, I’ll put the camera back into the bladder and then connect another Urolift device to the scope. I’ll repeat this process each time that I want to place an implant. Again, the number of implants will vary based on the size of your prostate as well as how the prostate looks when I’m down.
At the end of the procedure, I’ll give it one final look and make sure that we have a nice open channel that I feel confident that you will be able to be great. Hooray!!!
After the procedure is over, I’ll fill the bladder until you are full and take the camera out. We will check to see if you are able to pee and if so, ~90% of the time a catheter won’t need to be left in place. If you are unable to urinate or if I am worried about bleeding, I’ll leave a catheter at the conclusion of the procedure and take this out in a couple days. All in all, the Urolift procedure itself takes about 10-15 minutes.
So here is an image from the company website. It shows the Urolift Delivery Device that goes through the camera (cystoscope) and allows the urologist to place the Urolift Permanent Implant on either side of the prostate. Again, the number of implant will vary based on the prostate size.
How will I feel after the procedure is done?
Even though this is a quick office procedure, it is still a surgery in my book. There is swelling that develops at the site of the implants and healing that needs to take place on the inside. It is common for patients to note a pressure feeling and fullness in the rectum area. This pressure feeling usually goes away in a week or so. Additionally, it takes several weeks for the swelling on the inside to go away. This is why you will notice for the first month that your stream is still slow and some patients will notice urgency and frequency. This is why I will usually see you back in about a month and see how you are feeling. At this time, most patients will feel that they have recovered well, starting to notice that urination is much easier and we can talk about coming off your prostate medications.
Frequently Asked Questions
Most frequent questions and answers
What are the advantages of a Urolift?
- Can be done in the office
- Quicker recovery
- Ejaculation stays normal
- Erections don’t get messed up
- Can stop needing to take prostate medications daily
- Usually don’t need to have a catheter immediately after the procedure
How will I know if I am a good candidate for this?
Your urologist will do an evaluation to make sure that you have the right prostate size and shape.
If your prostate is larger than 100 gm, then this is not the right procedure for you. This can be evaluated by having an ultrasound on the prostate.
You also need the right prostate shape. Your urologist will typically as your workup perform a cystoscopy to look into the urethra with a camera and make sure that your ‘median lobe’ is not of a shape that you would prevent having a successful Urolift procedure.
Is this covered by insurance ?
Our office will review your insurance coverage but this should be covered by insurance.
Can I still get a MRI if need afterwards?
A Urolift implant is “MR Conditional”. After the procedure you will be given an implant card to be given to a radiology department if you ever need a MRI. As long as the MRI settings are appropriate, you can get a MRI if needed afterwards.
How do I know if I can get this procedure?
For a Urolift, in my hands you need the right prostate shape and size. If you don’t have the right type of prostate for this, then the outcomes may not be as desirable. This is why I will perform a couple tests to see if this is the right procedure for you.
One is a cystoscopy which is a camera test where we look inside the penis. I do this because if you have an enlarged median lobe (the middle portion of the prostate that can sometimes block the opening of the bladder), then I am not as comfortable in doing this procedure with this prostate shape.
The other test is a prostate ultrasound which takes me about two to three minutes where I place an ultrasound probe into the rectum. This allows me to adequately measure the size of the prostate because if the prostate is too big, the implants won’t be able to work properly. The cut off currently is if the prostate is larger than 100 grams in size.
What happens if my symptoms come back?
After the procedure is done, the urologist will follow you as typically is done for a man with an enlarged prostate. Usually, we will have you fill out a symptom questionnaire which can objectively track how your symptoms were before and after the procedure. On average, guys will note ~40 percent improvement in symptoms.
For some patients, their symptoms can come back over time as the prostate can continue to grow. In this instance, we will talk about whether restarting medications, repeating the Urolift, or any other procedure is indicated. Having a Urolift done does not prevent you from any other treatment option down the road.