What is the prostate gland?
The prostate is a walnut-shaped gland that forms part of the male reproductive system. The production of prostate fluid is its primary function. This fluid is crucial to fertility as it nourishes and transports sperm.
The prostate gland is found below the bladder and encircles the water pipe (the urethra carries urine from the bladder or, during orgasm, carries semen). The rectum forms part of the large bowel and lies behind the prostate gland.
What is benign prostatic hyperplasia (BPH)?
An enlarged prostate is a common finding in men over 50 and tends to progress as they grow older, leading to bothersome urinary symptoms.
In some men, the prostate grows only mildly; in others, it is more significant than expected, and in some, it can become huge. An enlarged prostate does not increase the risk of prostate cancer.
What are the urine symptoms of an enlarged prostate?
- difficulty to start passing urine
- a weak urine flow
- stop and start the (stuttering) flow
- need to strain to pass urine
- passing urine frequently
- nocturia: a need to wake up often at night to empty the bladder
- inability to hold urine
- the bladder is not emptied completely
What lifestyle changes are recommended?
- Switch to decaffeinated tea and decaffeinated coffee
- Lower the intake of fizzy drinks (including carbonated water), juices, and spices
- Avoid artificial sweeteners
- The last drink before sleep time should be three hours before.
- Loose weight
- Ensure regular bowel habits
What prescription medications are commonly issued?
- Alpha-blockers (tamsulosin/alfuzosin/ doxazosin). These relax the muscles in the bladder, bladder, neck and urethra and help to improve urine flow. These are typically the first-line bph medication prescribed.
- 5-Alpha reductase inhibitors (finasteride and dutasteride). These tablets shrink to some extent the size of the gigantic prostate glands and, to a certain degree, in some cases, stop it from growing larger.
- Phosphodiesterase inhibitors (Cialis) These drugs are mainly prescribed for erectile issues. However, they were found to improve urinary problems by relaxing muscles in the lower urinary tract.
- Anticholinergics (solifenacin, oxybutynin, and trospium) relax the bladder muscles, reducing bladder spasms. They mainly address overactive bladder symptoms.
- Combination of the above medications: The above medicines are initially prescribed as a stand-alone; however, if symptoms do not improve or bothersome symptoms worsen, a combination of drugs can be tried before considering surgical management.
Preparing for Urolift
If your procedure is planned under general anaesthesia or sedation, then you need to fast.
If you are taking blood thinners, your NHS consultant or private urologist will guide you on which medication to stop and for how long.
It is a day-case procedure, so you'll need someone to accompany you and take you home.
How is Urolift done?
You will be asked to lay flat and lift your legs in stirrups. The position is called lithotomy.
A local anaesthetic in the form of a gel will be introduced through the urethra (water pipe). If you are awake, you will feel mild stinging (lasts for up to 5 seconds).
A telescope will be introduced through the urethra allowing the surgeon to visualise the prostate and plan where the clips will be positioned.
The urological surgeon using the UroLift delivery device, will deploy four thin implants
compressing the enlarged prostate tissue.
If needed, a catheter may be placed.
What are the advantages of the UroLift treatment?
- Minimally invasive procedure.
- Day-case procedure
- It can be done under sedation or under local anesthesia as an outpatient treatment.
- Minimal impact on sexual function.
- Provide symptom relief quickly in most men, leading to a better quality of life.
- Clinical data showed significant improvement.
- Suitable for men who cannot undergo invasive surgical procedures due to their health
What are the risks or complications of the urolift?
Most of the side effects are short-lasting and resolve within four weeks
- Infection
- Bleeding
- Scar tissue
- Potentially, a lower ejaculatory volume
- Failure to relieve symptoms
- Some men go into urinary retention, for which they need a temporary catheter.
Are incisions done during Urolift?
No. Urolift is one of the many minimally invasive procedures. There are no skin cuts.
Is Urolift a high-risk surgery?
No. Urolift is not considered a high-risk surgery.
What happens after UroLift surgery?
Most patients go home on the same day of the UroLift procedure without a catheter.
In the early phase, you may experience the following:
Light bleeding with urine
Slight discomfort when passing urine
Increased need to empty the bladder. This can take up to 4 weeks to resolve.
Pelvic pain can take up to 4 weeks to settle. It is recommended to take paracetamol until the bleeding clears; then, they can take (if not contraindicated) an anti-inflammatory like ibuprofen). Epsom salt warm baths for 15 minutes help as well.
Recovering at home from Urolift system treatment
Most of the patients can return to their everyday life in a week.
Some patients return to work (that does not involve heavy lifting or straining) in 72 hours; however, urinary symptoms of urgency and light bleeding may still be experienced. So, planning needs to be factored in.
'50% of patients see an improvement
as early as two weeks from this minimally invasive approach.'
90% of men undergoing Urolift treatment see an improvement at four weeks.
Are there alternatives to Urolift for treating benign prostate hyperplasia?
Other options include the following.
- Transurethral resection of the prostate tissue (TURP). A specialised instrument is passed through the urethra (water pipe), and a loop through which current passes is used to shave the prostate tissue, widening the passage and allowing better urine flow.
- Holmium laser enucleation of the prostate (HoLEP). This uses a high-powered laser treatment to remove part of your prostate.
- Transurethral vaporisation of the prostate (TUVP). This involves using an electrical current to burn away parts of your prostate.
- Photoselective vaporisation (PVP). This technique uses a particular laser, destroying prostate tissue without leaving any fragments behind. It's sometimes called 'Greenlight' laser surgery.
- Transurethral incision of the prostate (TUIP). This involves your surgeon making minor cuts in the neck of your bladder and prostate to widen the bladder opening. It may be an option if your prostate is only slightly enlarged.
- Open prostatectomy. This surgery removes part of your prostate through a cut in your abdomen (tummy) instead of going through the urethra. As a more invasive surgery, it's usually only suggested for a large prostate.
- Prostate artery embolisation. This procedure blocks the blood supply to your prostate gland, causing some of the tissue to die and shrinking your prostate. It's a less invasive option that might be suitable for some men.
- Rezum steam treatment. This involves using stream treatment to destroy part of your prostate. The steam is delivered to your prostate using an instrument inserted through your urethra.
Your surgeon will talk to you about the most suitable treatment. Urolift and other treatment options will be discussed. This will depend on several factors, including how severe your symptoms are, how big your prostate is, whether you have any other health problems and what's available at your local hospital.
Reflection from a prostate expert
Urolift procedure is an option for benign prostatic hyperplasia bph surgical armamentarium. Not every man suffering from prostate enlargement will be eligible for this treatment.
Urolift treatment avoids the need for more invasive surgical procedures, so it is an option for those who are not fit yet suffering from severe waterwork troubles from enlarged prostate tissue.
The Urolift device use is an option for those men who do not want any erectile dysfunction risk commonly associated with other enlarged prostate surgery. Compromising sexual function can hurt the quality of life for some men.
The permanent implants deployed from the Urolift delivery device compress the enlarged prostate, providing sustained relief and an early return to a routine.
