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UroLift — Prostatic Urethral Lift (PUL) for BPH

The UroLift system (Teleflex, originally NeoTract) is an FDA-approved minimally invasive treatment for LUTS secondary to BPH that uses permanent nitinol–stainless-steel implants to mechanically retract obstructive prostatic lobes and widen the urethral lumen without cutting, heating, or removing tissue.[1][2] Within the BPH MIST family, UroLift is the non-ablative, non-resective, implant-based option — distinct from Rezūm (thermal), Aquablation (hydroablation), Optilume BPH (drug-coated balloon), iTIND (temporary nitinol), and TURP/HoLEP (resection/enucleation). For positioning vs other BPH options see BPH & Male LUTS — chooser.

Mechanism of action​

Each UroLift implant is a double-ended hook with three components[1]:

  • Super-elastic nitinol capsular tab (anchors on the prostatic capsule)
  • Polyethylene-terephthalate monofilament (transcapsular tether)
  • Stainless-steel urethral end piece (anchors on the urethral surface)

The delivery device deploys a fine needle through the prostatic lobe; the capsular tab anchors on the outer prostatic capsule and the urethral piece on the urethral surface. Tensioning compresses the obstructing lobe away from the urethra, opening the lumen.[1] Mechanism is fundamentally different from every other BPH MIST — neither ablative, resective, nor drug-eluting; the implant is permanent.

Procedure​

Under local anesthesia with oral or IV sedation (general or spinal also acceptable); typically < 1 hour[1][3][4]:

  1. 20 Fr rigid cystoscope with 0° lens.
  2. The implant delivery device is angled anterolaterally to compress the obstructive lobe.
  3. ~ 4 implants typically placed (2 per lateral lobe at the 2 and 10 o'clock positions); number adapted to anatomy. Multinational experience averaged 4.5 implants per case.[3]
  4. Patients return to normal activity at a mean of 8.6 days.
  5. Most patients do not require a postoperative catheter — a key practical advantage over other MISTs.

Patient selection​

Based on the L.I.F.T. pivotal trial and AUA 2023 Guideline Amendment[4][5]:

  • Men ≥ 50 years
  • IPSS ≥ 13
  • Qmax ≤ 12 mL/s (some studies allowed ≤ 15 mL/s)
  • Prostate volume 30–80 mL (original); expanded to ≤ 100 mL in some real-world settings
  • PVR < 250 mL

Median lobe — the MedLift extension​

The original L.I.F.T. trial excluded obstructive median lobe (OML). The MedLift study (FDA IDE extension) demonstrated UroLift safe and effective for OML with IPSS improvements ≥ 13.5 points and Qmax improvements 90–129% through 12 months — actually superior to lateral-lobe-only results (p ≤ 0.01).[6] Real-world data (Eure 2023) confirmed consistent OML outcomes.[7] AUA 2023 Amendment supports PUL for OML when the dedicated median-lobe device is used.[5]

Clinical efficacy​

L.I.F.T. — pivotal RCT​

206 men randomized 2:1 (PUL vs sham) at 19 North American / Australian centers[4][8]:

  • 3-month primary endpoint (blinded): IPSS −11.1 (PUL) vs −5.9 (sham), p = 0.003 — 88% greater improvement.
  • 12-month: IPSS 22.1 → 11.1; Qmax +4.0 mL/s.
TimepointIPSS ΔQoL ΔBPHII ΔQmax Δ
3 mo−11.1 (50%)50%52%+4.4 mL/s
12 mo−11.1 (50%)50%52%+4.0 mL/s
24 mo−9.7 (44%)50%52%+3.7 mL/s
5 yr−7.9 (36%)50%52%+3.9 mL/s (44%)

Improvements durable through 5 years with attenuation of IPSS improvement from 50% at 1 yr → 36% at 5 yr.[8]

BPH6 — PUL vs TURP RCT​

80 men, 10 European centers, 24-month follow-up[9][10]:

  • Both arms achieved significant IPSS improvement.
  • TURP → greater IPSS reduction and Qmax improvement.
  • PUL → superior for quality of recovery and ejaculatory function preservation (p < 0.05).

Multinational real-world​

102 men, 7 centers, 5 countries — mean 4.5 implants placed; IPSS −52%, QoL −53%, Qmax +51% at 12 months (p < 0.001).[3]

Sexual function preservation — PUL's strongest signal​

This is UroLift's defining attribute.[4][8][11][12][13]

  • 0% de novo erectile dysfunction in pivotal and follow-up studies.
  • 0% de novo ejaculatory dysfunction in the L.I.F.T. study and pivotal follow-up.
  • 0% anejaculation rate in the Franco 2026 Eur Urol pooled MIST analysis — the lowest of any MIST evaluated (alongside iTIND).[11]
  • Light 2021 Eur Urol network meta of 48 RCTs / 5,159 patients / 16 interventions: PUL ranked highest for erectile function at 1, 6, 12, and 24 months vs monopolar TURP, reaching significance at 24 months (MD 3.63, 95% CrI 0.14–7.11).[12]
  • Cahill 2026 SR/meta of 77 studies / 11,477 patients: PUL is one of only two MISTs that improved both IIEF and MSHQ-EjD function and bother scores.[13]
  • In MedLift, ≥ 40% of sexually active men improved the MCID for erectile function through 12 months.[6]

Safety profile​

Adverse events in clinical trials were mild to moderate and transient.[1][4][14] Cochrane (Jung 2019) found PUL likely increases minor adverse events vs sham (RR 1.69, 95% CI 1.33–2.16), all self-limited.[1]

Common AEs: dysuria, hematuria, pelvic pain, urinary urgency — typically resolving within 2–4 weeks. No catheter in most patients. Mean return-to-activity 8.6 days.

Real-world signal — FDA MAUDE database​

Real-world safety data diverge from clinical trial data. A MAUDE database analysis (Porto 2023 World J Urol) found UroLift was associated with significantly higher major (Level 3–4) complications (23%) vs Rezūm (7%) — primarily bleeding-related (hematoma, hematuria with clots requiring hospitalization).[15] A separate MAUDE analysis (Weiss 2021) found that 50.6% of PUL reports noted Level 3 or 4 complications, again primarily bleeding-related.[16] The clinical-trial vs real-world gap is real and warrants explicit shared-decision-making.

Retreatment and durability — the central limitation​

Clinical trial data:

  • L.I.F.T.: cumulative surgical retreatment 10.7% at 3 yr and 13.6% at 5 yr.[8][1]
  • BPH6: 6.8% at 1 yr (vs 5.7% TURP).[1]

Meta-analysis (Miller 2020 J Urol) of 11 studies / 2,016 patients[17]:

  • Annual surgical reintervention rate 6.0% / yr (95% CI 3.0–8.9).
  • Most common reinterventions: TURP / laser (51%), repeat PUL (32.7%), device explant (19.6%).

Real-world data — substantially higher:

SourcePopulation / databaseRetreatment finding
Helman 2025 J Endourol[18]MarketScan, 10,938 men5-yr surgical retreatment 22.3% for PUL (vs 7% HoLEP, 24.5% TUMT). 1-yr medical retreatment also higher after MIST vs traditional procedures (42.9% vs 27.3%)
Raizenne 2022[19]NY / CA population study1-yr and 3-yr reoperation 5.5% and 14.9%
Gaffney 2021[20]Premier Healthcare, 175,150 menPUL OR 1.78 for retreatment within 2 years vs TURP / photovaporization (p < 0.001)
Shin 2024 BJU Int NMA[21]12-month reintervention NMAUroLift ranked last among MISTs behind TURP, Aquablation, iTIND, and Rezūm

Guideline status​

The AUA 2023 Guideline Amendment provides a Conditional Recommendation for PUL in men with prostate volume 30–80 mL, based on Grade B evidence.[5] This is a stronger recommendation than iTIND (Expert Opinion) and equivalent to Rezūm. AUA notes PUL can be offered for lateral lobe and median lobe obstruction (with the dedicated MedLift device) and emphasizes its suitability under local anesthesia and in patients on anticoagulation.[1]

Comparison with other MISTs​

ProcedureIPSS Δ (12 mo)Qmax Δ (12 mo)Volume rangeMedian lobeImplant left?5-yr surgical retreatment (real-world)
UroLift (PUL)−11.1 (50%)+4.0 mL/s30–80 mL (≤ 100 in real world); MedLift for OMLTreatable with MedLift devicePermanent nitinol / steel implants22.3% (MarketScan)
Rezūm−11.3+5.630–80 mLTreatableNone4.4% (5-yr pivotal)
iTIND−9.3 (RCT) / −13.7 (single-arm)+3.5 / +14.725–75 mLExcludedNone (device removed)High per Italian Delphi
Optilume BPH−11.5+10.320–80 mLExcluded in trialsNoneNot yet 5-yr
Aquablation−15.1+10.330–150 mLTreatableNone~ 4.1%
TURP−15.1+10.6up to 80 mLTreatableNoneLowest of all options

Where UroLift fits​

Distinguishing advantages​

  • Only MIST that often requires no postoperative catheter.
  • Strongest erectile and ejaculatory function preservation of any BPH procedure with the longest follow-up data (5+ yr).
  • Performable under local anesthesia in the office.
  • Safe in patients on anticoagulants.
  • Can treat obstructive median lobes (with MedLift device).
  • Fastest recovery — return to activity ~ 1 week.
  • Does not preclude future procedures if retreatment is needed.

Principal limitations​

  • Highest real-world retreatment rate among MISTs — ~ 22% at 5 years (MarketScan).
  • Modest Qmax improvement (+ 3.7–4.4 mL/s) compared with Rezūm (+5.6), Optilume BPH (+10.3), Aquablation (+10.3), or TURP (+10.6).
  • Permanent implants in the body (vs iTIND's reversible reshape-and-remove or Optilume's non-implant approach).
  • Limited to prostates ≤ 80–100 mL (cannot treat very large glands; consider Aquablation, Simple Prostatectomy, or PAE).
  • Real-world bleeding and complication rates exceed clinical-trial reports (FDA MAUDE).
  • IPSS improvement attenuates over time (50% at 1 yr → 36% at 5 yr).

Imaging consideration for the reconstructive urologist​

UroLift implants are clearly visible on CT as paired metallic densities in the prostatic urethra and capsule. They should not be mistaken for foreign body, calculus, or migrated brachytherapy seed by readers unfamiliar with the device.

See also​

BPH & Male LUTS — chooser · Rezūm · iTIND · Optilume BPH · Prostate Artery Embolization · Simple Prostatectomy · Prostate Enucleation / HoLEP · UroLift device profile

References​

1. Jung JH, Reddy B, McCutcheon KA, et al. Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2019;5:CD012832. doi:10.1002/14651858.CD012832.pub2

2. Franco JV, Jung JH, Imamura M, et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database Syst Rev. 2021;7:CD013656. doi:10.1002/14651858.CD013656.pub2

3. McNicholas TA, Woo HH, Chin PT, et al. Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol. 2013;64(2):292-299. doi:10.1016/j.eururo.2013.01.008

4. Roehrborn CG, Gange SN, Shore ND, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. study. J Urol. 2013;190(6):2161-2167. doi:10.1016/j.juro.2013.05.116

5. Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol. 2024;211(1):11-19. doi:10.1097/JU.0000000000003698

6. Rukstalis D, Grier D, Stroup SP, et al. Prostatic urethral lift (PUL) for obstructive median lobes: 12 month results of the MedLift study. Prostate Cancer Prostatic Dis. 2019;22(3):411-419. doi:10.1038/s41391-018-0118-x

7. Eure G, Rukstalis D, Roehrborn C. Prostatic urethral lift for obstructive median lobes: consistent results across controlled trial and real-world settings. J Endourol. 2023;37(1):50-59. doi:10.1089/end.2022.0324

8. Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802-8813.

9. Sønksen J, Barber NJ, Speakman MJ, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015;68(4):643-652. doi:10.1016/j.eururo.2015.04.024

10. Gratzke C, Barber N, Speakman MJ, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int. 2017;119(5):767-775. doi:10.1111/bju.13714

11. Franco A, Ditonno F, Manfredi C, et al. Systematic review and pooled analysis of functional and sexual outcomes of minimally invasive surgical treatments for benign prostatic obstruction. Eur Urol. 2026;89(4):318-331. doi:10.1016/j.eururo.2025.09.004

12. Light A, Jabarkhyl D, Gilling P, et al. Erectile function following surgery for benign prostatic obstruction: a systematic review and network meta-analysis of randomised controlled trials. Eur Urol. 2021;80(2):174-187. doi:10.1016/j.eururo.2021.04.012

13. Cahill EM, Lindenbaum MM, Estright A, et al. The impact of minimally invasive surgical therapy for benign prostatic hyperplasia on sexual function: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2026. doi:10.1038/s41391-026-01091-x

14. Cantwell AL, Bogache WK, Richardson SF, et al. Multicentre prospective crossover study of the 'prostatic urethral lift' for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU Int. 2014;113(4):615-622. doi:10.1111/bju.12540

15. Porto JG, Arbelaez MCS, Blachman-Braun R, et al. Complications associated with minimally invasive surgical therapies (MIST) for surgical management of benign prostatic hyperplasia: a Manufacturer and User Facility Device Experience (MAUDE) database review. World J Urol. 2023;41(7):1975-1982. doi:10.1007/s00345-023-04440-w

16. Weiss JK, Santucci NM, Sajadi KP, Chouhan JD. Post-surgical complications after bladder outlet reducing surgery: an analysis of the FDA Manufacturer and User Facility Device Experience (MAUDE) database. Urology. 2021;156:211-215. doi:10.1016/j.urology.2021.04.030

17. Miller LE, Chughtai B, Dornbier RA, McVary KT. Surgical reintervention rate after prostatic urethral lift: systematic review and meta-analysis involving over 2,000 patients. J Urol. 2020;204(5):1019-1026. doi:10.1097/JU.0000000000001132

18. Helman T, Patil D, Marthi S, Browne B. Impact of endoscopic bladder outlet procedures on medical and surgical retreatment: a large population analysis. J Endourol. 2025;39(6):608-616. doi:10.1089/end.2024.0741

19. Raizenne BL, Zheng X, Mao J, et al. Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia. World J Urol. 2022;40(5):1185-1193. doi:10.1007/s00345-021-03926-9

20. Gaffney CD, Basourakos SP, Al Hussein Al Awamlh B, et al. Adoption, safety, and retreatment rates of prostatic urethral lift for benign prostatic enlargement. J Urol. 2021;206(2):409-415. doi:10.1097/JU.0000000000001757

21. Shin BNH, Qu L, Rhee H, Chung E. Systematic review and network meta-analysis of re-intervention rates of new surgical interventions for benign prostatic hyperplasia. BJU Int. 2024;134(2):155-165. doi:10.1111/bju.16304