Andrew Siegel MD 4/2/16
“Prostate lift” a.k.a. “Urolift,” is a new rather clever means of improving a man’s ability to urinate when it is compromised by obstruction of the urinary channel because of enlarged lateral prostate lobes.
The prostate is a male reproductive organ that produces prostate fluid, a milky liquid that serves as a nutrient vehicle for sperm. Similar to the breast, the prostate consists of glands that produce this milky fluid and ducts that convey the fluid into the urethra (urine and semen channel). The prostate completely surrounds the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of many troubles for the aging male.
The Enlarging Prostate
Benign prostatic hyperplasia (BPH) is one of the most common conditions of the aging male often causing bothersome lower urinary tract symptoms (LUTS)—urinary frequency, urgency, nighttime urination, weak and intermittent stream and the sensation of incomplete bladder emptying—that affect quality of life by interfering with normal daily activities and sleep patterns. The relationship between BPH and LUTS is complex because not all men with BPH develop LUTS, and LUTS are neither specific to nor exclusive to BPH. Urinary tract infections, prostate cancer, urethral scar tissue, and impaired bladder contractility (underactive bladder) are other problems that can mimic BPH.
Why Does The Prostate Enlarge?
Aging, genetic, and hormonal factors cause the prostate gland to gradually enlarge, with the process typically starting at about 40 years of age. As the prostate grows (hypertrophies), it puts pressure on the urethra, much as a hand squeezing a garden hose can affect the flow through the hose. Although larger prostates tend to cause more of this “crimping” than smaller prostates, this relationship is not precise.
UroLift (Prostate Urethral Lift)
UroLift is a new, minimally invasive means of treating prostate obstruction using a cystoscope (a small telescope that is positioned in the urethra to view the urethra, prostate and bladder) to place implants within the prostate to compress the obstructing prostate tissue. It opens the urethra so that the prostate no longer blocks the outflow of urine. It does so while leaving the prostate intact, not requiring cutting, heating, lasering or removal of prostate tissue. It is advantageous because of reduced bleeding and the preservation of erectile and ejaculatory function. It is important to know that it is not applicable to all men with prostate enlargement as it is only appropriate for certain prostate anatomies and sizes.
The technique uses mechanical compression of the encroaching lateral lobes of the prostate, creating an open channel. The implants are similar in action to molly bolts, resulting in crimping and tufting of the prostate tissue. The implants are deployed under direct visual guidance at the 2 o’clock and 10 o’clock positions using a needle that houses the components of the implant. The needle is passed through the full thickness of the prostate and upon retraction of the needle, the prostate capsule is engaged by a nitinol tab that is attached to an adjustable suture. The suture is placed under tension and a stainless steel urethral end piece is attached to the suture, securing the compression. Between two and ten implants may be used, depending on the size of the prostate gland.
Because the procedure does not remove tissue and avoids thermal energy, it has minimal — if any– adverse effects on erectile and ejaculatory function, a major advantage over many of the alternative treatments of BPH, both medical and surgical. Minor side effects include short-term urinary burning, urgency and blood in the urine. The procedure was pioneered in Australia in 2005, received FDA approval in 2013 and Medicare approval in 2016.
Bottom Line: The UroLift is a clever new procedure that is effective in alleviating the annoying symptoms of prostate obstruction in men with certain prostate anatomies and sizes. It alleviates obstruction without removing tissue by compressing the obstructing lateral (side) prostate lobes and does so without adversely affecting sexual or ejaculation function.
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.
Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.
Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women. Use code UROLOGY10 at check out for 10% discount.