UroLift (prostatic urethral lift, or PUL) uses small permanent implants to hold enlarged prostate lobes apart, creating a clear passage for urine without cutting, heat, or removing any tissue. FDA-approved since 2013, CE marked, and NICE-recommended (IPG475), it is performed under local anaesthetic as a same-day procedure taking around 15–20 minutes. Its defining clinical advantage is preservation of ejaculatory function in approximately 95% of men — a figure that compares very favourably with TURP (10–35% preserved) and Aquablation (around 90%). The trade-off is that symptom improvement is somewhat more modest than with tissue-removal procedures, and retreatment rates at five years are higher.
When men come to see me about an enlarged prostate, the conversation often circles around one concern: will treatment affect my sex life? For many men — particularly those who are younger or in an active relationship — this is not a minor footnote. It shapes the entire decision. UroLift was designed with that concern as its starting point. Rather than removing the obstructing tissue, it physically holds it out of the way — and in doing so, leaves the ejaculatory ducts and their surrounding anatomy entirely undisturbed.
What is the prostatic urethral lift — and why is it different?
The prostate sits around the urethra like a ring. When it enlarges, the lateral lobes squeeze inward, narrowing the channel that urine must pass through. Most BPH procedures address this by removing or destroying the offending tissue: TURP uses an electrified loop, Aquablation uses a robotically-guided waterjet, Rezum uses steam. UroLift takes an entirely different approach. Rather than removing the obstruction, it moves it out of the way.
Small permanent implants — each about the size of a staple — are delivered through the urethra using a purpose-built delivery device. Each implant grips the outer capsule of the prostate on one side, passes a thread through the lateral lobe, and anchors against the urethral wall. The tension retracts the lobe towards the capsule, physically opening the channel from within. Two to four implants are typically placed, symmetrically on each side.
No cutting takes place. No heat is applied. No tissue is removed or destroyed. This is why the procedure takes only 15 to 20 minutes, why recovery is faster than with most alternatives, and — most critically — why ejaculation is preserved in the large majority of men.
UroLift (NeoTract / Teleflex) received FDA approval in 2013 and CE marking in Europe. In the UK, NICE issued interventional procedures guidance IPG475 supporting its use for male lower urinary tract symptoms caused by benign prostatic hyperplasia, with the recommendation that it be performed with special arrangements for consent and audit or research.
How the implants work
Each UroLift implant consists of three components: a small nitinol tab that anchors to the outer fibromuscular capsule of the prostate, a monofilament thread that passes through the lateral lobe, and a suture end piece that sits against the inside wall of the urethra. Once deployed, the thread is under tension — pulling the lobe away from the urethral lumen and holding it there permanently.
Because no thermal energy is involved at any stage, the ejaculatory ducts — which run through the central zone of the prostate from back to front — are not at risk of heat damage. This is the fundamental reason ejaculatory function rates are so much better than with TURP, and somewhat better even than Aquablation (which, while heat-free, does remove tissue from the same zone).
The implants are permanent and MRI-conditional. If you need an MRI scan after having UroLift, always inform the radiology team in advance. Most 1.5T and 3T body scans can still be performed, but the reporting team needs to know the implants are present.
Who is UroLift suited to?
UroLift works best in a specific subset of men with BPH. In my clinical experience, the candidates who benefit most are those who:
- Have bothersome lower urinary tract symptoms — poor flow, frequent night trips, urgency — not adequately controlled by medication
- Have a prostate volume typically between 30 and 80 ml. The evidence base is strongest in this range; the L.I.F.T. trial enrolled men with prostates up to 80 ml and the data from larger glands is less consistent
- Have predominantly lateral lobe enlargement. A prominent median lobe — a lobe that projects upward into the bladder from the floor of the urethra — is generally not suited to standard UroLift, as the implants cannot adequately retract tissue in that configuration
- Are sexually active and prioritising ejaculation preservation over maximum symptom improvement
- Prefer a local anaesthetic day-case procedure rather than general anaesthesia with an overnight stay
- Are not in urinary retention at the time of treatment (acute retention is a relative contraindication)
UroLift is not the right treatment for everyone with BPH. Very large prostates, significant median lobe hypertrophy, a preference for the most definitive possible result, or a willingness to accept higher ejaculatory risk in exchange for greater symptom improvement may all point towards Aquablation, Rezum, HoLEP or TURP instead. Part of what I do at consultation is work through these options carefully for each individual.
How UroLift compares to other BPH treatments
Each BPH treatment makes different trade-offs between symptom improvement, side effects, durability, and anaesthetic requirements. The table below gives a practical overview.
| Feature | UroLift | Aquablation | Rezum | TURP |
|---|---|---|---|---|
| Mechanism | Retraction implants — no tissue removed | Robotic waterjet tissue removal | Steam ablation, tissue reabsorbs | Electrical loop resection |
| Prostate size | 30–80 ml (best evidence) | 30–150 ml | 30–80 ml | Small–medium (up to ~80 ml) |
| Median lobe | Generally unsuitable | Suitable | Some evidence for use | Suitable |
| Ejaculation preserved | ~95% of men | ~90% of men | ~90% of men | 10–35% of men |
| Anaesthetic | Local / sedation | General or spinal | Local / sedation | General or spinal |
| Hospital stay | Same day (no catheter usually) | 1–2 nights | Same day | 1–2 nights |
| IPSS improvement | ~50% at 12 months | ~70% (comparable to TURP) | ~50% at 12 months | ~70% at 12 months |
| 5-year retreatment rate | ~13% | ~5–8% (early data) | ~10–12% | ~5% |
| NICE status | Recommended (IPG475) | Recommended (TA593, 2020) | Recommended (IPG541) | Gold standard |
Rates are approximate and vary by study, prostate size, and individual anatomy. All decisions should be made following individual clinical assessment.
What happens on the day of the procedure
UroLift is almost always a day-case procedure — you arrive, have the treatment, and return home within a couple of hours. The standard approach uses local anaesthetic gel instilled into the urethra, sometimes combined with light intravenous sedation. General anaesthetic is an option for patients who prefer it or have specific clinical reasons for being fully asleep during the procedure. No incisions are made on the skin.
The delivery device — about the width of a standard cystoscope — passes through the urethra under direct camera vision. The urologist identifies each lateral lobe, positions the delivery system against it, and deploys an implant. The whole operating sequence takes around 15 to 20 minutes. Most men describe the experience as a combination of pressure and occasional brief sharp sensations as each implant fires.
A catheter is not routinely placed after UroLift — and this is one of the features that distinguishes it most clearly from TURP and Aquablation. Some men, particularly those who were already experiencing difficulty voiding before the procedure, may have a short-term catheter placed as a precaution, but for the majority there is nothing to take home.
Recovery — the first weeks
Recovery after UroLift is faster than after tissue-removal procedures, and most men are back to their normal routine within one to two weeks. The first few days are usually the most uncomfortable: urinary urgency, increased frequency, burning when passing urine, and occasional blood in the urine are all entirely expected as the tissue responds to the implants. These symptoms are managed with standard anti-inflammatory pain relief and settle steadily.
- Days 1–5: irritative urinary symptoms at their most noticeable; stay well hydrated; avoid strenuous activity
- Week 1–2: the burning and urgency ease substantially for most men; desk-based work is typically fine by the end of the first week
- Week 2–4: urinary flow progressively improves; most men notice a clear difference in stream by this point
- 3 months: the standard assessment point; IPSS scores and flow measurements at three months are the most reliable indicator of long-term outcome
- Sexual activity: generally safe to resume at two to four weeks once urethral irritation has fully settled
What the evidence says about outcomes
The L.I.F.T. (Luminal Improvement Following Prostatic Tissue Approximation) trial is the foundational clinical evidence for UroLift, with five-year follow-up published in 2019. Alongside this, real-world registry data from centres across the US, Europe and Australia gives a clearer picture of how the procedure performs in routine clinical practice.
- IPSS score: approximately 50% reduction in symptom burden at 12 months, sustained to five years
- Maximum urinary flow rate (Qmax): average improvement of approximately 3–4 ml/s
- Quality of life score: significant improvement in urinary quality of life measures
- Ejaculatory function preserved: in approximately 95% of men in the L.I.F.T. trial (4–5% risk of retrograde ejaculation)
- Retreatment rate: approximately 13% at five years — some men will require further treatment as benign prostate growth continues
The retreatment figure deserves an honest conversation. Compared with TURP, where retreatment rates at five years are around 5%, UroLift is clearly less definitive. The prostate continues to grow after UroLift in a way it does not after resection, because no tissue has been removed. For many men, this is an entirely acceptable trade-off — particularly if their priority is preserving ejaculation now, with the option of a more definitive procedure available later if needed. Others, who want the longest possible interval before any retreatment, may be better served by a tissue-removal approach from the outset.
Mr Ameen assesses suitability for UroLift — alongside the full range of BPH treatments including Aquablation, Rezum, and TURP — at his private clinics at the Wellington Hospital, 9 Harley Street, Chase Lodge Hospital, and Spire Bushey Hospital. Assessment always starts with prostate imaging and flow rate measurement to ensure the right procedure is matched to the individual's anatomy and priorities.
Questions worth asking at your BPH consultation
- Do I have median lobe enlargement, and does that affect my suitability for UroLift?
- What is my prostate volume, and does it fall in the range where the UroLift evidence is strongest?
- What symptom improvement would you realistically expect for me specifically — is 50% enough?
- What happens if the result is not satisfactory — what are my options from there?
- Weighing retreatment risk, ejaculatory outcomes, and symptom improvement — which procedure makes most sense for my priorities?
Frequently asked questions about UroLift
The procedure is done under local anaesthetic gel and optional sedation, so discomfort during surgery is minimal. Most men describe pressure and an occasional brief sharp sensation as each implant is deployed. Afterwards, urinary urgency, frequency and a burning sensation when passing urine are expected for one to two weeks — this is a normal tissue response and not a sign that anything has gone wrong. Standard anti-inflammatory pain relief manages it comfortably, and symptoms settle as the tissues adapt to the implants.
UroLift has not been shown to cause erectile dysfunction. Because no heat is applied and no tissue is removed from near the neurovascular bundles running along the outside of the prostate, the nerves responsible for erections are not at direct risk. The primary sexual consideration with UroLift is ejaculation, not erection: the L.I.F.T. trial found that approximately 95% of men retained normal ejaculatory function after the procedure. Erectile function scores were unchanged or improved in the majority of participants.
The implants are permanent, but they do not rule out more definitive surgery in the future. If a man subsequently needs TURP, Aquablation, or laser enucleation (HoLEP), the UroLift implants can generally be removed during that procedure without difficulty. This is one reason some men choose UroLift as a first intervention: it deals with their symptoms now while preserving the full range of surgical options later. What UroLift cannot be is "undone" to return the prostate to exactly its pre-procedure state, so the decision should still be made thoughtfully.
Both are minimally invasive day-case procedures that preserve ejaculatory function in most men, and both are NICE-recommended. The key differences: Rezum uses water vapour (steam) injected into the prostate to destroy the excess tissue, which then reabsorbs over four to six weeks — there is a period of recovery during which symptoms may temporarily worsen and a catheter is sometimes needed. UroLift involves no tissue destruction, no significant delay before improvement begins, and usually no catheter. However, UroLift is not appropriate where there is significant median lobe involvement, whereas Rezum has some evidence of efficacy in that setting. For prostates in the 30–80 ml range without median lobe, both are genuine options and the choice often comes down to anatomy and personal priorities.
Discuss UroLift at a private consultation
Mr Torath Ameen offers assessment and treatment for benign prostate enlargement at his London clinics. Choosing the right BPH procedure — UroLift, Aquablation, Rezum, or something else — starts with understanding your prostate anatomy and what matters most to you. Book a consultation to find out which option fits.
This article is intended for general patient education only and does not constitute medical advice. Individual suitability for UroLift or any other BPH procedure depends on anatomy, symptoms, and overall health, and must be assessed by a qualified urologist. Clinical decisions should always be made in consultation with a healthcare professional. If you are concerned about urinary symptoms, please seek prompt medical assessment.