Prostatic Urethral Lift

What is a prostatic urethral lift?

A prostatic urethral lift is a minimally invasive medical procedure that treats benign prostatic hyperplasia (BPH) symptoms that don’t respond to other therapies. BPH becomes more common as people assigned male at birth (AMAB) age. BPH is a noncancerous condition that causes your prostate to increase in size.

Your prostate is a small, walnut-shaped gland that surrounds your urethra and provides additional fluid to your semen (ejaculate). It has five rounded segments (lobes):

• One in the front (anterior).
• One in the back (posterior).
• Two on either side (lateral).
• One in the middle (median).

Urine (pee) and ejaculate leave your body through your urethra. If your prostate gets too big, it can make it difficult for pee and ejaculate to pass through your urethra.

Other names for a prostatic urethral lift include:

• PUL.
• UroLift®.

How common are prostatic urethral lifts?

The U.S. Food and Drug Administration (FDA) approved the prostatic urethral lift procedure in 2013. As of 2021, healthcare providers have performed the procedure over 200,000 times.

What happens before a prostatic urethral lift?

Before a prostatic urethral lift, you’ll meet with a healthcare provider. They’ll evaluate your general health and take vitals (temperature, pulse and blood pressure). They may also order tests or procedures to help determine the size of your prostate and the severity of your BPH, including:

• Urine flow test. This test measures the speed and strength of your pee stream. It also measures the amount of pee.
• Post-void residual volume test. This test measures how much pee is still in your urinary bladder after you pee.
• Transrectal ultrasound. A provider will insert a probe into your anus (butthole) to take images of your prostate. The probe uses high-energy sound waves, which travel through your rectum and bounce off organs and tissue in the area.
• Cystoscopy. During a cystoscopy, a provider will insert a small, flexible tool with a camera and a light at the end of it (cystoscope) to see inside your urethra and bladder.
• Urinalysis (urine test). A urine test evaluates how your pee looks, as well as any chemicals, bacteria or other microscopic components in your pee. If urinalysis shows bacteria in your pee (urinary tract infection or UTI), you may need to treat the infection before you can have a PUL.

How do I prepare for a prostatic urethral lift?

Tell your provider if you’re taking any prescription or over-the-counter (OTC) medications, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase your risk of bleeding.

Your provider will also give you specific directions on when to stop eating and drinking before the procedure. In preparing for a PUL, most people shouldn’t eat or drink anything at least six hours before the procedure. If you must take prescription medications by mouth, take them with a small sip of water.

A PUL may take place in an office or at an ambulatory surgery center. You’ll change into a hospital gown for the procedure, so it’s a good idea to wear clothes that are easy to take off.

Though a PUL is a minimally invasive procedure, it can be nerve-wracking whenever you go through a medical procedure. In most cases, a provider will give you a mild sedative to help you relax. It’s a good idea to have a friend or family member drive you home after the procedure.

What happens during a prostatic urethral lift?

A special team of healthcare providers will perform a prostatic urethral lift. The team typically includes a urologist (surgeon) and nurses.

A nurse will lead you to a surgical table and instruct you to lie on your back. You’ll lift your legs, spread them apart and bring them to rest in padded stirrups that keep your legs up and open (dorsal lithotomy position). This position allows your providers to see and access your urethra easily.

In most cases, a healthcare provider will give you local anesthesia. Local anesthesia numbs your urethra and the surrounding areas so you won’t feel pain during the procedure.

Once you’re numb, your surgical team will:

• Place a urinary catheter to drain pee from your bladder.
• Insert a cystoscope into your urethra and pass it through to your bladder to see inside your body as they perform the PUL.
• Insert a device (UroLift) into your urethra and move it forward to the side walls of your prostate. The UroLift then uses a small needle to eject small, thin, stainless-steel implants into both sides of your prostate. The implants pull prostate tissue away to open your urethra. Depending on your prostate’s size, your urologist may place two to six implants.

How long does a prostatic urethral lift take?

A prostatic urethral lift usually takes less than an hour.

What happens after a prostatic urethral lift?

After a PUL, your healthcare team will remove the UroLift device, take your legs out of the stirrups and help you off the table. They’ll then monitor you to ensure you don’t have any side effects, including difficulty peeing. Your urologist may insert a catheter if you can’t pee.

They’ll let you go home (discharge you) once they determine you no longer need monitoring.

What are the benefits of a prostatic urethral lift?

The primary benefit of a prostatic urethral lift is that it helps quickly relieve symptoms of BPH. You may no longer need a catheter to pee, and it can also reduce your risk of retrograde ejaculation. Retrograde ejaculation is when semen flows backward into your bladder instead of out through your penis.

Other PUL benefits include:

• It’s minimally invasive. Your recovery is more comfortable and faster than surgical treatments.
• It’s an outpatient procedure. The procedure usually takes less than an hour, and many can go home the same day without a catheter.
• It preserves sexual function. Other BPH treatment options may cause erectile dysfunction. After a PUL, you can continue to have sexual intercourse.

What is the success rate of a prostatic urethral lift?

The success rate of a prostatic urethral lift is higher than other BPH procedures with fewer risks after the procedure. Studies show that less than 14% of people who have a PUL need additional treatment after five years.

What are the downsides to a UroLift?

A prostatic urethral lift has some disadvantages. Healthcare providers may not be able to perform a PUL if you have:

• A very large prostate.
• A long urethra.
• Problems with urinary retention (you’re unable to empty your bladder when you pee).

There’s also a risk that your symptoms return and you need another PUL or surgery in the future.

Other complications may include:

• Needing to pee more often.
• Pain or discomfort when you pee.
• Blood in your pee (hematuria).
• UTI.

How painful is UroLift surgery?

You’ll have some pain and discomfort after a prostatic urethral lift. It may burn or sting when you pee, and you may have some pain in your pelvis. This can last for up to four weeks after a PUL. Most people manage their pain with over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

How long does it take to recover from a prostatic urethral lift?

It depends. Your body is unique, and how it responds to a prostatic urethral lift may differ from others. Most people feel better within a week, but it may take as long as four weeks.

Your healthcare team will give you instructions to follow after a PUL. They may include:

• Treat pain or soreness with over-the-counter pain relievers, such as an NSAID or acetaminophen (Tylenol®).
• Finish the full course of any other medicines they prescribe, such as antibiotics.
• Drink extra water to help clear blood from your pee and flush bacteria from your urinary tract to reduce your risk of a UTI.
• Avoid foods and drinks that can irritate your bladder, including alcohol, citrus juices, caffeinated drinks (coffee or tea) and spicy foods.

Can I have sex after a prostatic urethral lift?

Yes, you can have sexual intercourse after a prostatic urethral lift. But ask your healthcare provider when it’s safe to do so. You may have to avoid having sex and masturbating for up to a week.

How do I take care of myself after a prostatic urethral lift?

Schedule and keep follow-up appointments with your healthcare providers. Your first appointment will be a few weeks after your prostatic urethral lift. They may order imaging tests to make sure you’re healing appropriately. They’ll also make sure you can pee without any issues.

When can I go back to work/school?

Most people return to their daily activities a few days after a prostatic urethral lift, including school and work.

What is the outlook for people who have a prostatic urethral lift?

A prostatic urethral lift is still a relatively new procedure. But short- and medium-term studies show that the outlook for a PUL is good. Most people report that their quality of life improves significantly after the procedure.

When should I call a healthcare provider?

Call a healthcare provider right away if you:

• Can’t pee.
• Have very bloody pee.
• Still have blood in your pee two weeks after the procedure.
• Have signs of infection, including fever, chills or swollen testicles.

Is UroLift better than prostate removal?

UroLift is a highly effective and minimally invasive treatment. But it’s not any better than some BPH treatments as far as symptom relief. Its benefits include its ability to preserve ejaculation and possibly allow you to go home the same day without a catheter.

Healthcare providers generally first recommend a UroLift or other surgical procedure to treat BPH before prostate removal (simple prostatectomy). The categories of BPH procedures include:­ ­

Minimally invasive surgical treatment (MIST)

A provider will remove little prostate tissue — or no prostate tissue at all — and preserve your ability to ejaculate. They can perform these procedures in an office or ambulatory surgery center. In addition to UroLift, these procedures include:

• Rezūm™. This is a type of water vapor therapy. A provider inserts an instrument into your urethra. The instrument delivers steam to enlarged areas of your prostate. The steam destroys prostate cells and shrinks your prostate.
• Temporarily implanted nitinol device (iTind). A provider inserts a device into your urethra. The device gently reshapes and widens your urethra to allow pee to flow more easily. The provider removes the device after about a week.
• Transurethral incision of the prostate (TUIP). A provider uses a thin, lighted tube with a camera at the end (cystoscope) to access your prostate. Then, they use an electric current or laser to make tiny cuts in your prostate and the bottom of your bladder that connects to your urethra (bladder neck).

Invasive surgical treatment (IST)

A provider will remove your prostate to create a large channel, which increases your risk of retrograde ejaculation. They can perform these procedures in an ambulatory surgery center or hospital operating room. These procedures include:

• Transurethral resection of the prostate (TURP). During this procedure, a provider inserts a thin tool (resectoscope) into your urethra that uses an electric current or laser to remove part of your prostate.
• GreenLight™ laser. A provider uses a special laser to evaporate your enlarged prostate tissue.
• Aquablation®. A provider uses precise, high-pressure water jets to destroy enlarged prostate tissue.

Most invasive surgical therapy (MOST)

A provider will remove an entire noncancerous tumor (adenoma). They perform these procedures in a hospital operating room, and it requires at least an overnight stay. These procedures include:

• Holmium laser enucleation of the prostate (HoLEP). A provider inserts a resectoscope into your urethra to see your prostate. They then insert a laser into the resectoscope, which pulses beams into the enlarged areas of your prostate and removes any remaining prostate tissue with a suction device (morcellator).
• Robotic simple prostatectomy (RASP). This is a type of robotic surgery. A provider makes one or several small incisions to remove the inside part of your prostate.

Will my prostate grow after a UroLift?

Your prostate may continue to grow after a UroLift. But a UroLift is a generally safe, easy and successful procedure with a short recovery time. If your BPH symptoms come back, you may get a UroLift again.

A note from Cleveland Clinic

Benign prostatic hyperplasia is a common condition that affects many men and people AMAB as they age. But you don’t have to live with its complications. A prostatic urethral lift is a safe procedure that pulls prostate tissue away from your urethra to relieve BPH symptoms. The short- and medium-term success of a PUL is good. Talk to a healthcare provider about your questions or concerns. They’re here to help.