During the winter months, when temperatures drop, urinary symptoms in patients with benign prostatic hyperplasia (BPH) often worsen. Cold air causes blood vessels to constrict and increases muscle tension around the bladder and urethra, which can narrow the urethral passage. As a result, more patients who previously underwent treatment return to the clinic with recurring urinary symptoms. In particular, consultations for revision surgery following prostatic urethral lift procedures (UroLift) due to persistent discomfort or complications have been gradually increasing.
A Case of Implant Migration Into the Bladder Mucosa Successfully Treated With Revision Surgery
A man in his 60s visited the clinic after experiencing severe difficulty urinating for several years. Before undergoing treatment, he had been performing intermittent self-catheterization three times per day because he could barely urinate. Six years earlier, he had undergone a prostatic urethral lift procedure. At that time, his prostate measured 37 grams, but the median lobe was protruding into the bladder. This anatomical structure is known to reduce the effectiveness of the prostatic urethral lift procedure.
Four implants were inserted during the initial procedure, and the patient experienced temporary improvement in urinary flow. However, over time his symptoms returned, eventually progressing again to urinary retention. Follow-up examination revealed that one of the implants had migrated and penetrated into the bladder mucosa. Previous international studies have also reported that prostates with prominent median lobe enlargement have higher failure rates after prostatic urethral lift procedures compared with typical cases (Rukstalis et al., 2019).
The migrated implant was removed endoscopically, and the patient subsequently underwent holmium laser enucleation of the prostate (HoLEP). After surgery, normal urination was restored. Currently, the patient’s prostate size has reduced to approximately 11 grams, and his post-void residual urine volume remains stable at about 30 mL.
Advantages of the Prostatic Urethral Lift—But Only in Suitable Patients
The prostatic urethral lift procedure offers several advantages. Because it does not require surgical incision and can be performed under local anesthesia, it may be suitable for older patients or those who have difficulty undergoing general anesthesia. In addition, because the procedure does not remove prostate tissue, the risk of retrograde ejaculation is relatively low.
However, the procedure works by using small metallic implants to widen the urethral passage. Since enlarged prostate tissue is not removed, the long-term effectiveness may decrease over time. The metallic implants can loosen, shift position, or cause tissue reactions that reduce their therapeutic effect.
In particular, the procedure may be less effective in patients with prostates larger than 80 grams or those with median lobe enlargement that protrudes into the bladder. In such cases, implants may irritate the bladder or urethral lining, potentially causing pain, hematuria, recurrent inflammation, or even urinary retention.
International clinical studies have reported that the five-year retreatment rate after prostatic urethral lift procedures is approximately 13.6% (Canadian Journal of Urology, 2017). This rate may be even higher depending on the prostate anatomy, particularly in patients with median lobe protrusion.
Persistent Pain or Hematuria May Indicate the Need for Implant Removal
If an implant migrates into the bladder or becomes associated with stone formation, medication alone is unlikely to resolve the problem. In such cases, the implant must be removed endoscopically. If enlarged prostate tissue remains or urinary symptoms persist after removal, additional surgical treatment such as HoLEP may be necessary.
Symptoms such as a weakened urine stream, increasing residual urine volume, pain during urination, or recurrent hematuria may indicate reduced implant function. For this reason, regular follow-up examinations—including ultrasound imaging, uroflowmetry tests, and cystoscopic evaluation—are recommended.
The prostatic urethral lift procedure offers many benefits, including relatively quick recovery and preservation of sexual function. However, in patients with median lobe enlargement or abnormal implant positioning, revision surgery may sometimes be required.
During winter, urinary symptoms often worsen, and some patients who previously underwent treatment may notice a decline in treatment effectiveness. Ultimately, the most important factor in successful treatment is not the specific procedure performed in the past, but rather an accurate evaluation of the current prostate size, anatomical structure, and functional condition.
Urologic conditions that affect middle-aged and older adults can significantly impact quality of life. Through clear and accessible explanations of these conditions, the goal is to help patients better understand their health and make informed decisions about treatment.