An In-Depth UroLift Review: Key Steps, Structure, and Durability

Enlarged prostate, or benign prostatic hyperplasia (BPH), can cause bothersome urinary symptoms that impact daily life. The UroLift procedure offers a minimally invasive alternative to traditional treatments by physically opening the urethra without cutting, heating, or removing tissue.

This article examines the UroLift system’s structural components, how it interacts with prostatic tissue, and what patients can expect during and after placement.

Key Structural Components

The UroLift system repositions and secures prostatic tissue to relieve urinary obstruction caused by BPH. Each component plays a specific role in ensuring effectiveness while minimizing invasiveness.

Anchor Assembly

At the core of the system is the anchor assembly, consisting of two small, permanent implants—one inside the urethra and the other on the outer surface of the prostate. These implants work together to retract the prostate lobes, creating an open channel for urine flow.

The inner implant, typically made of nitinol (a nickel-titanium alloy), provides structural integrity and resists deformation. The outer component, constructed from stainless steel, ensures secure fixation to the prostatic capsule. This design prevents migration, as confirmed in long-term studies such as Roehrborn et al. (2017) in Urology, which reported sustained symptom relief over five years. The precision of anchor placement determines the degree of urethral opening and the procedure’s success.

Delivery Mechanism

The UroLift delivery mechanism is a handheld device that enables precise implant deployment. Inserted transurethrally, it includes a trigger-controlled needle mechanism that advances and secures the implants. A retractable sheath protects the urethral lining during insertion, reducing trauma.

The controlled release mechanism ensures implants are placed at a predetermined depth and angle, optimizing their ability to hold back the prostate lobes. The system is single-use, ensuring sterility and preventing cross-contamination. Studies such as Shore et al. (2014) in The Journal of Urology confirm that the precision of this device leads to consistent clinical outcomes.

Suture-Like Elements

While the UroLift system does not use traditional sutures, it features a fine, non-absorbable filament connecting the inner and outer implant components, functioning similarly to a tensioned suture. Made of polyethylene terephthalate (PET), this filament maintains constant tension, ensuring the prostate remains securely retracted.

Unlike absorbable sutures, the PET filament remains intact indefinitely, preventing tissue from re-encroaching into the urethra. Clinical evaluations, such as McVary et al. (2015) in The Canadian Journal of Urology, demonstrate that these elements maintain their structural integrity for years, contributing to long-term symptom relief.

Mechanism Of Action On Prostatic Tissue

The UroLift system alleviates urinary obstruction in BPH by mechanically repositioning the lateral prostate lobes, widening the urethral lumen. Unlike thermal or ablative techniques that destroy tissue, this approach preserves prostatic integrity while providing immediate symptom relief.

Upon deployment, the inner implant anchors within the urethra, while the outer implant affixes to the prostatic capsule, creating a constant outward pull. The PET filament maintains sustained tension, preventing the prostate from returning to its obstructive position. Histological studies, such as those by Roehrborn et al. (2017) in Urology, confirm long-term stability without significant implant displacement.

The immediate urethral expansion improves urinary flow, as demonstrated by urodynamic assessments in clinical trials. Patients often experience a reduction in the International Prostate Symptom Score (IPSS) within weeks. Unlike medications that rely on hormonal modulation or muscle relaxation, this intervention produces structural modification without systemic side effects. The absence of thermal injury reduces risks associated with tissue necrosis or scarring seen in laser or electrosurgical treatments.

Procedural Steps

The UroLift procedure begins with the patient in a dorsal lithotomy or supine position for optimal urethral access. A cystoscope is inserted to visualize the prostatic urethra and assess the degree of obstruction. After evaluating the anatomy, the UroLift delivery device is introduced transurethrally to align with the obstructing tissue.

The physician identifies target locations along the urethral wall for implant placement, typically starting near the bladder neck and progressing distally. The first implant is deployed by engaging the trigger mechanism, which advances the needle through the prostatic tissue and secures the outer anchor against the capsule. The PET filament is then tensioned to retract the lateral lobe, immediately widening the urethral lumen.

This process is repeated at multiple points along each prostate lobe, with most patients requiring four to six implants. The number and distribution depend on prostate volume and lobe symmetry, assessed through preoperative imaging or cystoscopic evaluation.

Once all implants are in place, the device is withdrawn, and the urethra is inspected to confirm a sustained opening. Patients are monitored briefly for transient hematuria or dysuria, which may occur due to mechanical manipulation. Since UroLift does not involve thermal ablation or tissue removal, recovery is typically rapid, with most individuals resuming normal activities within days. Studies indicate that symptom relief is noticeable within two weeks, with sustained improvements documented for years.

Materials And Durability

The UroLift system is designed for long-term durability, using biocompatible materials that maintain structural integrity. The implants consist of a nitinol inner anchor and a stainless steel outer component, both chosen for their resistance to corrosion and mechanical fatigue. Nitinol, commonly used in vascular stents, conforms to tissue while withstanding physiological stresses. Stainless steel reinforces stability, ensuring secure fixation to the prostatic capsule.

The PET filament, widely used in medical applications such as heart valve sutures and surgical meshes, resists enzymatic degradation and mechanical wear. This ensures that the tension needed to maintain urethral patency does not diminish over time. Long-term studies, including five-year follow-up data from randomized clinical trials, indicate that the implants remain in place without significant migration or structural failure. Patients continue to experience symptom relief at rates comparable to more invasive surgical procedures.

Tissue Behavior During And After Placement

Once UroLift implants are positioned, the prostatic tissue adapts to the mechanical forces exerted by the device. The immediate effect is the separation of the prostate lobes, restoring urethral patency and improving urinary flow. Unlike thermal ablation or resection techniques that induce necrosis and scarring, this approach preserves prostate histology. The absence of tissue destruction minimizes inflammation, leading to a quicker resolution of postoperative irritation. Mild swelling may occur in the first few days but subsides as the tissue acclimates to the implants.

Over time, the prostate undergoes remodeling in response to sustained outward traction. Fibrotic encapsulation around the implants ensures stability, preventing displacement or inward migration. Serial cystoscopic evaluations confirm that the urethral lumen remains expanded for years without significant tissue encroachment. The mechanical separation also reduces dynamic obstruction, as the prostate no longer exerts pressure on the urethra during voiding.

This long-term stability contributes to durable symptom relief, with clinical trials reporting sustained improvements in urinary flow and patient outcomes over five years. Unlike medications that require continuous use, the UroLift system provides a one-time intervention with lasting benefits.