A prostatic urethral lift (PUL) is a minimally invasive treatment for urinary symptoms caused by an enlarged prostate. For men seeking an alternative to daily medication or more invasive surgeries, PUL directly addresses the blockage by mechanically opening the urinary channel. This procedure aims to improve urinary function and quality of life by holding obstructive tissue apart.
The Challenge of Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. This walnut-sized gland is located below the bladder and surrounds the urethra, the tube carrying urine out of the body. As men age, the prostate naturally grows, and the prevalence of BPH increases, affecting about half of men in their 50s and up to 90% by age 85.
This enlargement becomes problematic when the prostate tissue compresses the urethra, narrowing the urinary pathway. The obstruction leads to lower urinary tract symptoms (LUTS), such as difficulty starting urination, a weak or interrupted stream, and a feeling that the bladder is not completely empty.
The condition also affects the bladder, which must work harder to push urine through the narrowed channel. Over time, the bladder wall can become thicker and more sensitive. This leads to storage-related symptoms like a sudden urge to urinate, increased daytime frequency, and the need to wake up at night to urinate (nocturia), all of which can impact quality of life.
Mechanism of the Prostatic Urethral Lift
The Prostatic Urethral Lift (PUL) works by physically holding obstructive prostate tissue away from the urethra, creating a wider channel for urine. Unlike other procedures, PUL does not involve cutting, heating, or removing prostate tissue. It uses the UroLift® System, which deploys tiny, permanent implants that act like tie-backs to pull the enlarged prostatic lobes apart, immediately opening the urethra.
A urologist uses a specialized delivery device passed through the urethra to the blockage. Small implants are deployed to secure the enlarged tissue. Each implant has a nitinol capsular tab anchored on the prostate’s outer surface and a stainless steel endpiece on the inner urethral wall. A suture connects them, creating tension that holds the prostate lobe in a retracted position.
The number of implants used, between two and six, depends on the specific size and shape of the patient’s prostate. While the urethra is widened immediately, a biological response also occurs over time. The compressed tissue remodels, which contributes to durable symptom relief, and the implants become fully encapsulated within the tissue, ensuring they remain safely in place.
Patient Suitability and Pre-Procedure Considerations
A urologist performs a thorough evaluation to determine if a patient is a suitable candidate for PUL. The procedure is intended for men aged 50 and older with moderate to severe BPH symptoms who are seeking an alternative to medication or more invasive surgery. An important factor for many is the low risk of causing new, lasting erectile or ejaculatory dysfunction.
Specific physical criteria must be met. Ideal candidates have a prostate volume between 30 and 100 cubic centimeters. The procedure is less suitable for men with a significantly obstructive median lobe, a part of the prostate that can grow into the bladder opening. Contraindications include an active urinary tract infection or conditions that prevent inserting the delivery device.
Before recommending PUL, a urologist will conduct several diagnostic tests to assess symptoms and anatomy. These tests include:
- An International Prostate Symptom Score (IPSS) questionnaire to quantify symptom severity.
- A urine flow test (uroflowmetry) to measure the speed and strength of the urinary stream.
- A post-void residual (PVR) volume test using ultrasound to measure urine remaining in the bladder.
- A cystoscopy, using a thin scope to visually inspect the urethra and bladder and assess the prostate’s shape.
The PUL Procedure Day and Immediate Aftermath
The Prostatic Urethral Lift is performed in an outpatient setting, with most patients returning home the same day. The procedure is quick, lasting between 15 and 30 minutes. It can be performed under local anesthesia, light sedation, or general anesthesia, making it an option for men with higher risks associated with general anesthesia.
After anesthesia is administered for comfort, the urologist inserts the UroLift delivery device through the urethra. Using cystoscopic visualization, the surgeon places the implants to hold the obstructive prostate tissue apart. Once the urethra is visibly more open, the device is removed.
Patients are monitored in a recovery area as the anesthesia wears off. A urinary catheter is often not needed or is only required for a short time. Common temporary side effects in the first few days can include:
- Mild pain or a burning sensation during urination.
- A small amount of blood in the urine.
- Pelvic discomfort.
- An increased sense of urinary urgency.
Discharge instructions advise resting for 24-48 hours and avoiding strenuous activity.
Long-Term Symptom Relief and Lifestyle Impact
After the initial recovery, patients experience a gradual and lasting improvement in urinary symptoms. While some relief is immediate, significant changes become more apparent within a few weeks as post-procedural irritation subsides. Patients report a stronger urine stream, reduced urinary frequency and urgency, and fewer nighttime awakenings, leading to an enhanced quality of life.
A primary benefit of the PUL procedure is its impact on sexual health. Clinical studies show that it does not cause new, sustained erectile or ejaculatory dysfunction. This preservation of sexual function is a reason many sexually active men choose PUL over other BPH therapies that carry a higher risk of these side effects.
The relief provided by the UroLift implants is designed to be durable. Follow-up studies have demonstrated that the positive effects on symptoms and quality of life are sustained for years after the procedure. Because the permanent implants continue to hold the prostate tissue aside, the urinary channel remains open. Should symptoms return, the procedure does not preclude patients from pursuing other BPH treatments.