372 http://tau.sagepub.com Ther Adv Urol 2016, Vol. 8(6) 372–376 DOI: 10.1177/ 1756287216671497 © The Author(s), 2016. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav Therapeutic Advances in Urology Introduction The prevalence of benign prostatic hyperplasia (BPH) in men and its association with age are well established in the urological literature [Loeb et al. 2009]. The symptomatic sequelae of this disease can lead to significant symptoms and treatment challenges, which are encountered by urology and primary care professionals alike. Surgery remains the therapeutic cornerstone when pharmacologi- cal options are exhausted. In an era fuelled by advancements in minimally-invasive technologies, the ‘UroLift’ device (NeoTract Inc., Pleasanton, CA, USA), formally known as the prostatic ure- thral lift (PUL), is the latest addition to the surgi- cal toolkit available to urologists treating men with bothersome lower urinary tract symptoms (LUTS) secondary to BPH [Jones et al. 2016a]. This non- ablative minimally-invasive option is postulated to deliver sustainable improvements in functional outcomes while maintaining a strong safety profile and causing minimal de novo sexual dysfunction [Garcia et al. 2015]. Key objectives for any new surgical intervention are to demonstrate clinical efficacy, safety, long-term durability and eco- nomic feasibility. Since the first original study on UroLift in 2011 with a case series of 19 patients, it has gone on to gain regulatory approval by the United States (US) Food and Drug Administration (FDA) in 2013 and the United Kingdom (UK) National Institute of Clinical Excellence (NICE) in 2015 with subsequent adoption and dissemina- tion across a number of countries worldwide [Woo et al. 2011]. With increasing availability of the UroLift device, education and awareness is needed in order to update and guide treatment strategies accord- ingly as well as augment reproducibility. To this effect, the objective of this article is to provide an overview of this novel technique and discuss key considerations for management in patients with BPH. The procedure In contrast to other endoscopic, minimally-inva- sive treatments for BPH, the modus operandum of the UroLift technology is mechanical rather than ablative or cavitating [Garcia et al. 2015]. Carried out in the lithotomy position under cystoscopic guidance, deployment of adjustable implants serves to retract the obstructing lateral lobes and create an open, continuous voiding channel through the prosatic fossa, from the verumonta- num up to the bladder neck. The device itself is a custom designed disposable cartridge consisting of a nitinol capsular tab and a urethral stainless steel tab (8 mm) bridged in between by a nonab- sorbable polyethylene terephthalate (PET) mono- filament suture. The initial deployment is 1.5 cm distal to the bladder neck with the needle path kept parallel to the bladder neck. The second deployment is just anterior to the verumontanum, with additional implants placed between these two, with the idea to open a continuous channel through the anterior aspect of prostate. The num- ber of implants is dependent on the adenoma size and configuration (range 2–10 according to Garcia et al. 2015) and these are typically placed at the 2 o’clock and 10 o’clock positions (angled anterolaterally), at least 1.5 cm distal to the blad- der neck in order to preserve its integrity. This tissue-sparing method allows for expansion of the urethral lumen and theoretically avoids damage to the dorsal venous complex and the primary neurovascular bundles. It can be performed under UroLift: a new minimally-invasive treatment for benign prostatic hyperplasia Patrick Jones, Bhavan P. Rai, Omar Aboumarzouk and Bhaskar K. Somani Abstract: ‘UroLift’ has emerged as a new minimally-invasive nonablative surgical technique for benign prostatic hyperplasia (BPH). We discuss the procedure, cost, evidence, advantages and disadvantages of this procedure. It is a novel technology suitable for a selected group of patients that allows for a bespoke treatment for men with BPH. Keywords: BPH, prostate, PUL, UroLift Correspondence to: Bhaskar K. Somani, MRCS, FEBU, FRCS (Urol) Department of Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK bhaskarsomani@yahoo. com Bhavan Prasad Rai, MRCS, FRCS (Urol) James Cook University Hospital, South Tees Hospital NHS Foundation Trust, UK Omar Aboumarzouk, MRCS, FRCS (Urol) Department of Urology, Bristol Urological Institute, Bristol, UK Patrick Jones, MRCS Department of Urology, Blackpool Victoria Hospital, Blackpool, UK 671497TAU 0 0 10.1177/1756287216671497Therapeutic advances in UrologyP Jones, BP Rai research-article 2016 Review