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Introducing the Urolift System

Over the past two decades, prostate treatments have witnessed the extraordinary union of technological progress along with the refinement of surgical technique; leaving urologists with a wide armamentarium for both benign and malignant prostatic disease.


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Over the past two decades, prostate treatments have witnessed the extraordinary union of technological progress along with the refinement of surgical technique; leaving urologists with a wide armamentarium for both benign and malignant prostatic disease.

Surgical treatment for benign prostate hyperplasia (BPH) has been underpinned by the durability of transurethral resection of the prostate (TURP), itself founded on Harold Hopkins’ description of rod-lens endoscopy. Whereas, ablative therapies, such as transurethral microwave therapy (TUMT) and transurethral needle ablation (TUNA) have never challenged the dominance of TURP, more recent challengers such as bipolar energy and laser energy offer the benefits of TURP (removal of obstructive tissue) with some greater safety features (in terms of bleeding, TUR syndrome, etc), reflected by their widespread adoption.

However, the main side effect of any of these procedures is retrograde ejaculation, reported in up to 80-90% of patients. This has clearly significant implications, particularly in those who wish to fully preserve active sexual function.

This is a key reason why the development of the UroLift® System is an exciting adjunct to existing treatment strategies. It relieves prostate obstruction and opens the urethra directly by retracting the obstructing prostatic lobes without cutting, heating,

or removing prostate tissue. The device is applied by endoscopic equipment which urologists routinely use, pushing aside the obstructive prostate lobe. Small, permanent UroLift® implants are deployed, holding the lobes in the retracted position, and thus opening the urethra while leaving the prostate intact.

In January 2014, the National Institute for Health and Clinical Excellence (NICE) issued an Interventional Procedure Guidance (IPG) approving its use in the UK, gaining CE mark in Europe and FDA clearance in the USA. In the UK, the UroLift® System is indicated for the treatment of outflow obstruction, secondary to BPH, in men aged 50+. The safety and efficacy of the UroLift® System has been demonstrated in numerous studies, including a randomised double-blinded study from the USA, a European retrospective registry, and several open label studies. Improvement in urinary symptoms, as seen through reduction in IPSS (International Prostate Symptom Score), has been consistent across the various studies, showing rapid relief within two weeks and sustained effect to two years.

What are the benefits of the UroLift® System over traditional TURP or laser procedures?

Bleeding is much less than with TURP, with a 0% transfusion rate to date for UroLift® vs. 5%-7% for TURP. Postoperative catheterisation has been shown to be 30%-35% (compared to standard protocol for TURP) with a mean duration of 0.9 days (compared to 1-5 days for TURP). An additional unique benefit is the preservation of sexual function. In all studies to date, there has been 0% incidence of de novo, sustained erectile dysfunction or ejaculatory dysfunction.

What are the side effects?

In our clinical studies to date, the most common adverse events reported included: hematuria, dysuria, micturition urgency, pelvic pain, and urge incontinence. Most symptoms were mild to moderate in severity and resolved within two to four weeks after the procedure. The primary contraindication to the UroLift® System is an obstructive or protruding median lobe of the prostate.


Keywords

Dr Ranan Dasgupta, erectile dysfunction, urolift, urology,side effects, prostate, prostatic disease, malignant, BPH, transurethral resection of the prostate, TURP, TUNA, NICE, IPSS



Issue
Number:
20
Title:
Coronary Disease: A new era in percutaneous treatment
Published:
June 2015
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Mr Ranan Dasgupta

Consultant Urologist

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