Are you suffering from irritating urinary symptoms, like an unbearable and urgent need to go, nighttime urination, slow, weak and interrupted urinary flow? More than 500 million aging men worldwide suffer from an enlarged prostate, also known as BPH (benign prostatic hyperplasia). BPH is a non-cancerous growth of the prostate, but can certainly coexist with prostate cancer. As the prostate grows with age from BPH the urethra (the urinary tube that eventually exits the penis) becomes pinched off or obstructed. Though rarely life-threatening, BPH causes progressive urinary symptoms that can often wreak havoc on everyday living. Historically doctors have used various medications (for example, Flomax/tamsulosin and Avodart/dutasteride). Although these work for some men, nearly a third of men on these medications discontinue their use within a year (for reasons of side effects, cost and/or just plain hassle). If a man doesn’t tolerate drugs for BPH or if those drugs fail to help his bothersome symptoms, procedural options exist. Prior to a few years ago the standard procedure was the TransUrethral Resection of the Prostate (TURP)—whereby an urologist using a scope under an anesthetic trims away the obstructing prostate tissue. This procedure was invented in the 1930s and a few refinements have been made to it. Nevertheless TURP can cause significant side effects in some men (bleeding, scarring, sexual difficulties and anesthesia complication); for this reason, alternative procedures have gained favor (including laser procedures—which still require anesthesia and minimally invasive options like microwave and radiofrequency procedures). Importantly, TransUrethral Microwave Therapy (TUMT) and TransUrethral Needle Ablation (radiofrequency – (TUNA) procedures were designed to be performed in office, under some form of local anesthesia—I will say that having performed TUMT hundreds of times the anesthetic wasn’t always adequate (the actual microwave time lasts almost 30 minutes and this time can be grueling for patients (I’ve heard similar things about TUNA); also the longevity of the improvement is often shorter than we would like. Thus, urologists have been in search of a minimally invasive BPH procedure that is safe, with few side effects, durably effective and well-tolerated in an office setting under local anesthesia. After its invention in 2005 and initial launch in Australia, and with extensive clinical investigation in the U.S., I can now offer patients long lasting BPH relief found after a short and nearly painless procedure known as the UroLift® System, from NeoTract, Inc. (Pleasanton, CA).
UroLift® is an FDA-cleared (ref), ground-breaking medical device that is helping men urinate freely and comfortably again. This minimally-invasive implant opens up the blocked urethra by lifting or holding enlarged prostate tissue out of the way with small permanent implants placed through a scope into the obstructing prostate tissue; an average of 4 implants are used per procedure, opening the prostate at different levels and creating in essence a new, unobstructed channel within the prostate. UroLift® represents a mechanical solution to BPH; there is no cutting, heating or removal of
…there is no cutting, heating, or removal of prostatic tissue.
prostate tissue. Think of it as a window curtain tie-back that holds the lobes of the enlarged prostate open, relieving obstruction virtually immediately. While appropriate for many prostates, certain prostate shapes and sizes preclude UroLift®, and some screening procedures are required to qualify a patient for it.
The entire UroLift® procedure can be performed very efficiently in an urologist’s office; after the numbing takes place (with anesthetic jelly into the tip of the penis), the implants are delivered fairly quickly, so that the entire procedure takes less than an hour. Men are fully awake and alert with minimal pain or discomfort during the procedure. There’s usually no catheter afterward, nor are there significant postoperative restrictions, and importantly, to date there are NO KNOWN SEXUAL SIDE EFFECTS. In my clinical experience, most men even drive themselves home. The response is rapid, durable, and sometimes almost immediate, though patients should expect some post-procedural blood in the urine and burning with urination; those side effects almost always improve by the typical 2-week follow up appointment.
I first learned of this revolutionary device through the Australian trials in the late 2000s. Then I had the absolute privilege of meeting Ted Lamson, PhD, the inventor, who personally presented data to me from those early clinical studies. It almost seemed too good to be true, and I’ll admit I was skeptical at first, particularly with the potential for tolerability under local anesthesia. After further research however, I knew that this device could revolutionize BPH care, and I became a Prinicipal Investigator in the U.S. trials. As such, I was the first urologist in North America in February 2011 to perform the UroLift® System and also the first in the world to perform the procedure under local anesthesia. I was quickly impressed!
I have now successfully performed the UroLift® System in over 100 men, all well-tolerated under local anesthesia in my office; very few needed catheters and most have experienced incredible results. But the UroLift® System’s biggest advocate might just be my retired urologist partner, Dr. Stephen Richardson, who decided to undergo the procedure to relieve his BPH symptoms.
“Being a board certified urologist who treated BPH for 30 years, I knew the options and I chose not to go the medical therapy route and didn’t like what I had seen of the TUMT or TUNA procedures,” said Dr. Richardson. “I wanted to wait until something was available that could be done in the office, didn’t have any sexual side effects and that I didn’t have to take every day for the rest of my life. UroLift was the best solution for my needs. I can’t guarantee that it will work for you, but it has worked for many men and it worked for me.” Steve tolerated the procedure very well, and was back to work and exercise within a couple of days. He now serves as a resource for other men interested in UroLift®. I find that people want to hear it from another patient, and he is doubly qualified to speak to them.
Beyond providing nearly immediate relief from irritating BPH symptoms, the UroLift® System has few—if any—side effects. Other procedures like TURP or laser surgery, can cause permanent side effects, like the loss of the ability to ejaculate and even erectile dysfunction. As mentioned above, negative side effects are minimal with the UroLift® System, and I have never seen a serious complication of this implanted device.
An unanswered but important question is “Can UroLift® be used after radiation for prostate cancer?” TURP is notoriously a problem for these men; increased risk of scar formation and, even worse, incontinence can follow. I have experience with a handful of men, after either brachytherapy or external beam radiation, who were unable to urinate on their own or had lots of obstructive symptoms. UroLift seemed much safer to me than TURP, and those radiated patients I have treated with UroLift® have all done well. Obviously more data is needed before we can say with confidence that UroLift® is safe and effective for post radiation patients, but we already know TURP is not.
As time goes on (I’m now in my 4th year of UroLift® implantation) I’ve been very happy to hear from the many men whose lives have changed because of this device. I have also had the pleasure of regularly interacting with the brilliantly talented and conscientious team from NeoTract. Additionally, I have been privileged to be involved with training other Urologists new to UroLift®. So if you have irritating urinary symptoms, I strongly encourage you to learn more about the ground-breaking UroLift® System (see www.urolift.com for starters). It might just change your life.
By Steven N. Gange, MD, FACS, Western Urological Clinic, Salt Lake City, firstname.lastname@example.org