A 65-year-old man visited the outpatient clinic with persistent urinary discomfort. He had previously taken medication for benign prostatic hyperplasia (BPH) for several months without significant improvement. As a result, he underwent a prostate urethral lift procedure (UroLift) at another hospital. During the procedure, four implants were placed on each side of the prostate. It had been two years since the surgery.
Although his urinary flow rate was relatively stable after the procedure, he continued to experience perineal pain and frequent urination. Because the symptoms persisted, he visited our clinic for further evaluation. After performing standard prostate examinations, we decided that revision surgery was necessary. The previously inserted UroLift implants were removed, and holmium laser enucleation of the prostate (HoLEP) was performed to remove the enlarged prostate tissue. Following surgery, the prostate urethra was successfully reopened, and the patient’s perineal pain resolved along with his urinary symptoms.
This case highlights an important point: when urinary symptoms recur or persistent perineal pain develops after a prostate urethral lift procedure, removal of the implants and additional treatment may need to be considered.
The prostate urethral lift procedure, commonly known as UroLift, is a minimally invasive treatment for benign prostatic hyperplasia. Instead of removing prostate tissue, small permanent implants are used to pull the enlarged prostate lobes apart, widening the urethra and improving urine flow. Because the procedure does not involve cutting or removing prostate tissue, it can often be performed under local anesthesia and generally carries a lower risk of surgical complications.
UroLift can be particularly effective for patients who have relatively small prostates without significant median lobe enlargement. It may also be suitable for patients with underlying medical conditions that make general anesthesia difficult.
However, like any medical procedure, UroLift does not guarantee permanent results for every patient. In certain situations, revision surgery may become necessary.
One situation involves persistent perineal pain, which refers to pain in the area between the scrotum and the anus. Because UroLift implants hold the prostate tissue in place by pulling it outward, implants that are deeply anchored may sometimes cause discomfort in the surrounding tissues. In most patients, this discomfort improves within about three months after the procedure. However, in some cases, the pain may persist even one to two years after surgery. When this occurs, removal of the implants may be considered.
Another situation that requires careful evaluation is persistent hematuria, or blood in the urine. In rare cases, the UroLift implant may protrude beyond the prostate tissue toward the bladder. When this occurs, stones can form around the exposed implant. These stones may cause ongoing bleeding or urinary irritation. If stones develop within the bladder, patients may experience symptoms such as urinary urgency, frequent urination, or difficulty holding urine. In these cases, imaging studies or cystoscopy may be needed to evaluate the surgical area and identify potential complications.
A third situation involves the recurrence of urinary symptoms due to continued prostate enlargement. Because the prostate continues to grow with age, the mechanical effect of the implants may gradually weaken over time. If urinary symptoms return to a level similar to those experienced before surgery, additional treatment may be required. Studies have reported that approximately 13.6% of patients may require retreatment within five years after a UroLift procedure.
When any of these three situations occur—persistent perineal pain, ongoing hematuria, or recurrence of urinary symptoms—revision surgery may be necessary. Revision procedures typically involve removing the existing implants and performing definitive prostate surgery to remove the obstructing tissue. While several surgical options exist for treating benign prostatic hyperplasia, in our clinical practice, revision procedures are often performed using holmium laser enucleation of the prostate (HoLEP), which has demonstrated high patient satisfaction and strong clinical outcomes.
According to data from the Health Insurance Review and Assessment Service (HIRA) in Korea, the number of patients diagnosed with benign prostatic hyperplasia has increased by approximately 19.7% over the past five years. In 2022 alone, more than 1.4 million men were diagnosed with BPH. As the number of patients continues to grow, a wide range of surgical treatments has been introduced in Korea, including the UroLift procedure.
However, no surgical treatment can guarantee perfect results in every case, and revision procedures may sometimes be necessary. If symptoms such as persistent perineal pain, hematuria, or recurrent urinary problems develop after treatment, patients are strongly encouraged not to ignore these symptoms and to consult a urology specialist for further evaluation.
As men age, various urologic conditions can begin to interfere with daily life. Providing clear and practical information about urologic health can help support a healthier and more comfortable life during middle age and beyond.