Prostatic urethral lift

Overview

A prostatic urethral lift is a minimally invasive procedure designed to treat symptoms of benign prostatic hyperplasia (BPH) that are unresponsive to other treatments. BPH, a noncancerous condition causing the prostate to enlarge, becomes more prevalent as individuals Assigned Male at Birth (AMAB) get older.

The prostate is a small, walnut-shaped gland that encircles the urethra and adds extra fluid to semen (ejaculate). It is composed of five rounded segments (lobes):

• The anterior (front) one.
• The posterior one, located in back.
• Two lateral (on either side).
• The median, or one in the middle.

The urethra serves as the exit point for both urine and ejaculate. If the prostate becomes enlarged, it can obstruct the passage of urine and ejaculate through the urethra.

An alternative term for a prostatic urethral lift is UroLift or PUL.

Risks

Prostatic urethral lifts are not without their drawbacks. Doctors might not be able to do a PUL if you:

• A very large prostate.
• Issues with urine retention, which is the inability to completely empty your bladder after urinating.
• An elongated urethra.

There’s also a chance that your symptoms could come back and you’ll eventually require another operation or PUL.

Additional issues could be:

• Hematuria (blood in the urine).
• Urinary tract infection (UTI).
• Having frequent urination needs.
• Pain or discomfort during urination.

Before the procedure

You will consult with a healthcare professional before to a prostatic urethral lift. They will take your vital signs (blood pressure, pulse, and temperature) and assess your general health. In order to assess the severity of your BPH and the size of your prostate, they might additionally prescribe the following tests or procedures:

• Test for urine flow. This test determines the force and speed of your urine stream. It measures the volume of urine as well.
• Post-void residual volume test. The amount of urine that remains in your bladder after urinating is measured by this test.
• Transrectal ultrasound. To capture pictures of your prostate, a healthcare professional will put a probe into your anus, or butthole. High-energy sound waves are used by the probe; these vibrations pass through your rectum and reverberate off surrounding tissue and organs.
• Cystoscopy. A physician will insert a small, flexible device called a cystoscope—which has a camera and a light at the end—during a cystoscopy to view within your bladder and urethra.
• Urinalysis. A urine test assesses the appearance of your urine in addition to any chemicals, germs, or other microscopic elements found in it. Prior to having a PUL, you might need to treat a Urinary Tract Infection (UTI) if a urinalysis reveals germs in your urine.

Inform your doctor about any prescription or over-the-counter (OTC) medications you are taking, including herbal supplements. Some substances, such as aspirin, anti-inflammatory drugs, and certain herbal supplements, can increase the risk of bleeding.

Your doctor will provide specific instructions on when to stop eating and drinking before the procedure. For a prostatic urethral lift, it’s generally recommended to avoid food and drinks for at least six hours prior. If you need to take prescription medications, do so with only a small sip of water.

A PUL can be performed in a doctor’s office or an ambulatory surgery center. Wear clothes that are easy to remove, as you’ll need to change into a hospital gown.

Although a PUL is minimally invasive, any medical procedure can be stressful. Typically, a mild sedative will be administered to help you relax. It’s a good idea to have a friend or family member drive you home afterward.

During the procedure

A prostatic urethral lift will be performed by a team of medical professionals. Usually, nurses and a urologist (surgeon) make up the team.

After guiding you to a surgical table, a nurse will give you the go-ahead to lie on your back. Your legs will be raised, split apart, and brought to rest in the dorsal lithotomy position while wearing padded stirrups. Your urethra can be easily viewed and accessed by your doctor due to its position.

A doctor will usually administer local anesthetic to you. To make the surgery painless for you, local anesthetic numbs the urethra and its surroundings.

Following your numbness, your surgical team will:

• Insert a urinary catheter to remove waste products from your bladder.
• As they conduct the PUL, insert a cystoscope into your urethra and pass it through to your bladder to view inside of your body.
• Insert the UroLift device into your urethra and advance it to the prostate’s side walls. Subsequently, the UroLift inserts tiny, thin stainless-steel implants into either side of your prostate using a tiny needle. The implants separate the prostate tissue, allowing your urethra to open. The number of implants your urologist places will depend on the size of your prostate.

In most cases, a prostatic urethral lift takes less than an hour.

After the procedure

After a prostatic urethral lift (PUL), a member of your healthcare team will help you off the table, remove the UroLift device, and free your legs from the stirrups. They will monitor you to ensure you don’t experience any adverse effects, such as difficulty urinating. If you’re unable to urinate, your urologist may place a catheter.

Once your doctor determines that you no longer need supervision, you will be discharged and allowed to go home.

Outcome

It varies. Because everybody is different, there may be differences in the way yours reacts to a prostatic urethral lift. Although it can take up to four weeks, most people recover in a week.

Following a PUL, you will receive instructions from your doctor. They could consist of:

• Use over-the-counter painkillers, such as acetaminophen or NSAIDs, to treat discomfort or soreness.
• Complete the entire course of any additional medications, such as antibiotics, that they recommend.
• To lower your risk of a UTI, drink more water to help flush bacteria from your urinary system and remove blood from your urine.
• Steer clear of beverages and foods that can irritate your bladder, such as citrus juices, alcohol, caffeinated beverages, and spicy meals.

Sexual activity is allowed after a prostatic urethral lift, but you should consult your doctor to determine when it is safe to resume. You may need to avoid masturbating and having sex for up to a week following the procedure.

Prostatic urethral lifts have shown higher success rates and fewer post-procedural risks compared to other BPH surgeries. Studies indicate that less than 14% of patients require additional treatment five years after undergoing a PUL.