The most heavily marketed BPH procedure right now is the Urolift, a widely offered and popular procedure. Although many urology groups still perform it in private surgery centers, it is designed to be an office procedure. Unlike any other procedure, a Urolift does not heat or cut prostate tissue. This device fires sutures through the wall of the prostate and then employs something akin to a grappling hook outside the prostate. Thus, when the suture is pulled on and tightened, the effect is to pull the wall of the prostate open. Several sutures are used depending on the prostatic anatomy. As with most office procedures, the patient should expect an approximately 80% success rate. The stated advantages of the Urolift are that results are more immediate than with its main competitor, the Rezum procedure, and that theoretically, it will maintain semen volume better than the Rezum. It is also advertised as a procedure that may be done without using a catheter afterward, although in practice, many patients are still left with a catheter after a Urolift for a day or two.
When done as an office procedure and not in an operating room, Urolift can be an excellent procedure, particularly for patients who highly value their semen volume. However, as more and more patients have these procedures, it is becoming evident that leaving permanent foreign bodies in the prostate that can cause irritative symptoms or become infected is not ideal. The suture also can obscure MRI screening for prostate cancer, and more serious complications such as pelvic bleeding or hematoma formation requiring hospitalization are not seen with Rezum or TUNA/Prostiva.
Dr. Engel has performed hundreds of TUNA/Prostiva and Rezum procedures. When choosing between the performance of these procedures and Urolift, Dr. Engel chose the Rezum with TUNA secondary for certain situations. This is because Urolift cannot be realistically offered to all anatomies, other procedures avoid leaving foreign bodies behind, and we avoid the risk of more major complications. By the time Dr. Engel offers an office procedure to a patient, few still have high semen volume, and it is relatively rare to find someone who holds this as a very high priority. Rezum and TUNA/Prostiva patients have to wait a month or so to see the full benefit, but most of these patients have already been on meds or have been contemplating a procedure for years. Waiting an extra month or so has not been a factor for most patients.
Finally, Urolift is marketed as an alternative to ever taking medical therapy, and that does not tend to align with Dr. Engel’s paradigm of progressive treatment for BPH. For all these reasons, Dr. Engel has not thus far committed to the Urolift procedure.