Prostatic urethral lift (UroLift) is one of the treatment options for benign prostatic hyperplasia (BPH). The procedure works by using small implants to pull the enlarged prostate tissue to each side, thereby widening the urethra and improving urine flow. Unlike procedures that remove prostate tissue or burn it with a laser, UroLift is a relatively simple procedure that is usually performed under local anesthesia. Because of this, it has the advantage of a lower risk of complications and side effects. It is particularly considered effective for patients who cannot undergo general anesthesia due to chronic illnesses, as well as for those with relatively small prostates and no enlargement of the median lobe.
However, like any surgical treatment, the effects of the prostatic urethral lift do not always last permanently. In some patients, additional surgery may become necessary over time. Common reasons include persistent perineal pain, ongoing hematuria, or the recurrence of urinary symptoms.
One possible issue is pain in the perineal area, which lies between the testicles and the anus. In the UroLift procedure, implants are used to pull the enlarged prostate tissue outward and secure it in place. If the implants are fixed too deeply, they may cause discomfort or pain in the perineal region. In most cases, this pain improves within about three months after surgery. However, in rare situations, the pain may persist even one to two years after the procedure. In such cases, removal of the implants through revision surgery may be considered.
Another situation that requires attention is persistent blood in the urine. In some cases, the implanted sutures or devices may protrude outside the prostate or toward the bladder. When this happens, stones can form around the exposed implant, leading to continuous hematuria. If such stones develop inside the bladder, patients may experience frequent urination or an urgent need to urinate. When these symptoms occur, further evaluation using ultrasound or cystoscopy may be necessary to reassess the treated area.
A third possibility is the recurrence of urinary symptoms due to continued enlargement of the prostate. Since the prostate may keep growing as part of the aging process, the effect of the implants may gradually weaken over time. If urinary symptoms return and become as uncomfortable as before the procedure, revision surgery may need to be considered.
When any of these three situations occur, additional surgery for BPH may be necessary. Revision procedures often involve removing the existing implants and performing a prostate tissue removal procedure. Among the various surgical options currently available, holmium laser enucleation of the prostate (HoLEP) has become widely performed in recent years.
Dr. Choi Ho-cheol of Goldman Urology Clinic’s Dongtan branch explained that as the number of patients with BPH continues to increase, a variety of surgical techniques have been introduced in Korea, including UroLift. However, he emphasized that no surgical treatment is completely perfect, and revision surgery may sometimes be required. He advised that patients who experience the symptoms mentioned above should consult a urology specialist to determine the most appropriate course of treatment.