So many examples of bad outcomes from Urolift. The man I recently saw had the complication I hoped I would never see. This one is devastating. He had a Urolift. It failed. Salvage surgery was complicated. Now he is incontinent. It’s not so much that Urolift isn’t effective beyond a very short number of months. If there were no serious complications; if the only down side were time and money wasted, then that’s the market driven model we live in.
But the complications can be debilitating. They can be life threatening. Not conjecture. Documented. Published.
This image is from a published paper. A vulnerable man, no doubt counseled in the safety and efficacy of this “minimally invasive” procedure, experienced this life threatening retroperitoneal bleed, subsequent ICU stay, and dialysis. Who knows what else. This is not an isolated event.
1 to 5 liter blood losses were common in the era of open prostate cancer surgery:The retropubic retroperitoneal space is treacherous. Thin, weak veins drape over the prostate. Surgeons who painstakingly dissect this region during radical prostatectomy seemingly blindly pierce through this area with Urolift as if the regions anatomy has changed. Piercing through a region replete with friable vascular structures is exactly what Urolift purports to do.
The Good news: Urolift doesn’t do what it says it does.
The capsular anchoring portions of Urolift usually land short of their intended destination. They mostly anchor in the more flimsy tissue peripheral to the transition zone. Animated images on marketing material illustrate a well positioned anchor on the exterior prostate capsule. Real-life experience bolstered by advanced imaging and surgical salvage tells the real story.
The graphic depiction of how the procedure is advertised
The MRI reality of what really happens to these clips as they get displaced and begin to migrate
Bad from the good:This translates to poorly anchored metallic foreign bodies
migrating within the prostate over time as the body does what it does to foreign
structures: isolates and extrudes. Not only are they not going to hold the prostate channel open, but they are now free to find themselves eroding into the bladder, rectum and urinary sphincter.
Ultrasound image of migrating clip
The cystoscopic view from the bulbous urethra of eroded Urolift clip and suture distal to the sphincter
Other complications: Recalcitrant chronic pain, and incontinence. The least serious but most voluminous complication is need for salvage therapeutic surgeries. Those that should have been done in the first place. It's easy to gloss over, but the sheer numbers of salvage surgeries is enormous. The increased risk. The increased risk. It should be unconscionable.
There are viable options to address a man's bladder outlet obstruction. We can debate the merits of one over the other. It’s a legitimate debate. Urolift isn’t one them.
Like the “Teflon Don” who stayed out of jail until he didn’t, hopefully fate will catch up
with this black eye of urology
The Center for Men's and Women's Urology, 24076 SE Stark Street, Suite 310, Gresham, Oregon 97030, United States of America, 503.492.6510
