Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system

Abstract

The prostatic urethral lift procedure, more commonly known as UroLift, has been designed to improve male lower urinary tract symptoms while avoiding the complications and disadvantages of existing drug and surgical therapies. In particular, UroLift does not damage ejaculatory function or affect orgasmic sensation. It appears an option for men who wish to avoid long-term drug therapy, the side effects of drugs or surgery and who do not need or will not accept traditional surgical treatments. UroLift was introduced following a series of planned studies that led to US Food and Drug Administration approval in September 2013. UroLift has recently been approved by the UK National Institute for Clinical and Health Excellence (September 2015) as effective and safe and cost-effective for use in the UK health system. This review describes the device and the procedure and the evidence base that has led to those approvals.

Keywords: BPH; LUTS prostatic hyperplasia; UroLift; minimally invasive; prostatic urethral lift.

Figure 1

Applying a tissue retracting implant between the urethra and the prostatic capsule lifts the urethra toward the capsule thereby expanding the urethral lumen. Notes: Because the prostate capsule is firm, fibromuscular tissue and the glandular lobe tissue is compressible and sponge-like (A), when the prostate wall is compressed, the urethra is lifted toward the outer capsule, and the capsule holds position. Thus, the prostatic urethra can be opened (B).

Figure 2

UroLift^® system handpiece and implant. Notes: The handpiece is passed under vision down the urethra and into the prostatic channel. The lateral prostatic lobes are separated to open the channel and fixed in the operator’s chosen position by firing the handpiece mechanism that delivers an implant. The implant consists of: an urethral end piece made of surgical steel; a capsular tab made of nitinol; and a length of suture made of PET. During the procedure, the suture is cut to a customized length by the handpiece under the direction of the surgeon. Abbreviation: PET, polyethylene terephthalate.

Figure 3

Images of male prostatic urethra before (A) and immediately after (B) insertion of UroLift implants. Note: Image used with patient’s permission.

Figure 4

Timeline of UroLift milestones. Abbreviations: BPH, benign prostatic hyperplasia; TURP, transurethral resection of the prostate; LOCAL, UroLift system tOlerability and reCovery when Administering Local Anesthesia; FDA, US Food and Drug Administration; NHS, National Health Service; NICE, National Institute for Clinical and Health Excellence; MTEP, Medical Technologies Evaluation Programme.