YAFU (Yet Another Failed Urolift)
Posted , 5 users are following.
Hi All,
I have been lurking here for the last couple of years and benefiting from the advice and personal stories. So I decided to join and share my story so others can have another data point. I am 52 very active and in great health generally. I have had a slow stream and hesitation problems for quite some years so I decided to address the problem. After doing much research, I started leaning towards Urolift due to its lack of sexual side effects and relatively quick recovery time.
I live in a major metro area in the US so I was able to find a great Urolift urologist who has done hundreds of procedures and is designated a Urolift COE by Teleflex. He did tests (32 grams, 8 ml/s max flow) and a cystoscopy and told me I was a good candidate. He said the procedure is likely to provide a major relief of the symptoms and it would be pretty easy to recover from. He said likely 3 days of rest, 7 days to going back to normal, and 2 weeks before sex and exercise.
I woke up from the procedure with a catheter and in horrible pain. They sent me home but that evening but the pain was so horrible that I had to remove the catheter after talking to the doctor. I went through 14 days of terrible pain before it started to calm down. The procedure made a small improvement when it came to starting and ending the stream but the flow didn't seem any better. I did more follow up tests at 4 weeks and 6 months both of which showed the flow hadn't improved.
At the 6 months my flow started to slow and hesitation problems came back. He did another cystoscopy and told me there is a problem with one of the implants where it has ended up in my bladder and part of the PET suture is exposed in my bladder (there were 6 implants total). He said the implant can only be removed using a modified resection procedure, contrary to the marketing literature by Teleflex. To be precise, this implant is not responsible for my continued LUTS symptoms which he said is caused by a high bladder neck. His position is that I had both lateral lobes and a high bladder neck that were causing LUTS.
At this time my only option is a procedure that removes tissue in order to get the implant out so I don't have the option of doing PAE or other non-invasive procedures. I have scheduled time with two other Urolift practitioners to get 2nd and 3rd opinions to determine what the best way forward is for me.
I did some more research and it looks like around 10% of Urolift implants end up in the bladder. Add that to the other causes of failures and success of Urolift drops to maybe 70% or so and even when successful the symptom relief is pretty modest compared to other procedures, likely requiring additional procedures sooner than those of other options.
Final advice: Urolift is not as safe and effective as advertised. Consider all your options carefully and keep up with forums like this and the scientific literature before making your decision.
3 likes, 13 replies
russ_777 derek_m
Edited
Derek, sorry you're having those issues. Can you point me to where you saw the 10% end up in the bladder thing? I'm curious to know how that happens and how that number was determined.
derek_m russ_777
Edited
Hi Russ, I don't remember which review came up with that number but the 5-year follow up of L.I.F.T study found that 10/206 patients had removed encrusted implants exposed to bladder, 3/206 had removed non encrusted implants exposed to bladder so that is 13/206=6.3%. A further 2.1% were observed to have implants exposed to bladder via 1-year cystoscopy making the total 8.4%.
This number accounts only for the incidents of implants exposed to bladder that were observed or removed in isolation. Any cases in which removal of such implants also included placing new implants, or if they had to be removed using a resection were reported separately in the re-treatment group which was 13.6%.
Here is the report for your reading pleasure:
https://www.canjurol.com/html/free-articles/V24I3_08_FREE_DrRoehrborn.pdf
russ_777 derek_m
Edited
Derek, thanks for the link. I read the paper and I think your 10% proof is right there. You should be using 140 for the denominator in that calculation instead of 206. 206 is the total number of randomized enrollees. Only 140 of them actually received the UroLift implants, the rest were the sham subgroup. So 13/140 is just under 10%.
I'm puzzled by that number. I guess I can see how a needle could be deployed entering the lateral lobe near the bladder neck and because the bladder neck might be pushed up towards the bladder by the median lobe shoot across the gap to penetrate the bladder wall.It seems like doing a concurrent TRUS might help the urologist visualize where the bladder vessel wall is in relation to where he intends to deploy the most proximal needle.
derek_m russ_777
Posted
You are right Russ, the denominator should be 140, thanks for catching that. I have an appointment with another urologist next week and I will ask him how this happens. But your guess sounds pretty good to me.
hank1953 derek_m
Edited
Love the abbreviated YAFU ! From what I've seen on this forum for the last 4 years, Urolift is more like a disaster, not anything near the 70% success rate you mentioned. Hank
derek_m hank1953
Posted
Yeah I didn't want to speculate a lower success rate without having hard data. For instance, anecdotally people doing Holep procedures after failed Urolifts are finding the Nitinol tabs that are stuck in the prostate rather than making it to the outer wall for correct anchoring. Such things don't get detected or reported by the studies. I know of a couple of urologists in the area who have stopped doing Urolifts and do Rezum instead.
rob78162 derek_m
Edited
I got Yafu'ed in August 2015. It was never clear to me how many clips were deployed as the operation notes that I obtained were not clear. I don't want to hijack the thread but if desired I can post the blurb from the op report. In any case, my problem was my median lobe and at that time Urolift was not approved to address median lobes. They do have a way of doing it now but I wouldn't trust it as that is even closer to the bladder than the lateral lobes. Who knows where they deploy the anchors up there, right? I had a TURP almost 3 weeks ago and I'm healing up nicely. My urologist/surgeon said she did a thorough resection and could only find two clips. She sheared them off from the lateral lobe but there really is no way to remove the anchor from the capsule so they'll remain there, hopefully buried in tissue, and not work their way loose and get lodged in my urethra.
My Urolift surgeon was not a nice guy, I never really liked him or his office staff, but he gave me the hard sell telling me that it would be super easy. I didn't trust my gut. He noted my median lobe during the cystoscopy prior to the procedure and said that the procedure would probably only be a double, not a home run, but that it was definitely worth doing. He said that he could do it in the office and that I could play tackle football the next day and that I wouldn't require a catheter. I ended up having it done in the hospital, had a catheter for a couple of days, and a very difficult recovery over the next six weeks.
The place where I go now (a part of the University of California system) has multiple urologists/surgeons on staff but I don't think that they do many Urolifts any more, mostly TURPS and Rezums.
I think that many urologists jumped on the Urolift bandwagon because they could go for a weekend seminar, get certified and that it sounded like the best thing since sliced bread. I think that it overpromised and underdelivered to many men and I wish that I had never done it.
Rob
derek_m rob78162
Posted
Hi Rob. Sorry to read about your YAFU but glad you are healing nicely from the TURP. Hopefully you will never have to worry this again, and I don't think you will have any issues with the capsule clips. I agree with you about Urolift. Easy, lucrative, and low risk (supposedly), why wouldn't uros jump on board?
Feel free to share whatever you want in this thread. I am happy to make this a general YAFU thread for all.
russ_777 rob78162
Posted
Rob, I had a similar experience with my recent aquablation procedure. The ablation exposed 3 of the 5 UroLift clips (minus the capsular tabs which as you noted can't be removed by a transurethral approach) that he was able to remove. From talking with my surgeon and my regular urologist neither of them think it is an issue as long as the metallic urethral end piece stays embedded in the remaining prostatic fossa.As long as they're not exposed to urine there's no chance they'll form deposits and become a problem. If you want to know whether they're still buried in there that can be done with a pelvic xray.
rob78162 russ_777
Posted
Hi Derek/Russ, yes, the prevailing opinion seems to be that embedded pieces in the capsule should not cause a problem. I think that Urolift was FDA approved in 2013 and if we assume that the procedure became common out in the wild a couple of years later in 2015 we can see now at the 5 year mark that urologists/surgeons are learning how to deal with the clips while doing additional procedures. I specifically asked my surgeon if she had done a TURP on a patient who had previously had a Urolift and I was happy to hear (for my sake) that she had. Anyway, here is the relevant part of my op report from 5 years ago and as I said it's a little bit hard to figure out how many clips were deployed but I gather two and my surgeon said that she was very diligent in looking for them and only found two. She said that she normally finds 4 and thinks that because the urologist was an early adopter that he was conservative and only did two. As I mentioned above, he downgraded me from a homer to a double because of my median lobe and I truly believe that he only did the procedure as a notch in his belt and probably knew that deploying any more than 2 clips was not productive. When I had my pre-TURP cystoscopy I was watching along on the screen and saw the median lobe and one of the clips and the doctor told me 'Oh, that Urolift didn't have a chance of working'.
derek_m rob78162
Posted
Definitely sounds like only two implants. My doctor didn't tell me how many and has been refusing to send me the surgery report, but he billed the insurance for 6 implants. I am going to send a legal document requesting the report so we will see.
rob78162 derek_m
Posted
Yes, two clips seems to be the consensus. I seem to remember him telling me in a followup office visit that the gun misfired at some point, which could be what his verbiage refers to as 'one of the anchors didn't deploy'.
Regarding your doctor not providing you with the surgery report, that's out of line and illegal. If you are in the U.S. those are YOUR records under HIPAA laws and not only are you entitled to each and every document but I believe that there are stipulations specified for timely delivery after request. I did have to fill out a one page release document and pay $15. I just pulled the doc up and it is pretty straightforward and is called 'Authorization for the Use and/or Disclosure of Protected Health Information'. I'm sure that your Urologist has a similar form(s). From there you just select what docs you want (tests, procedures, surgeries, etc.) and for what date range. I believe that I signed a waiver pre surgery to agree to mediation and not sue (pretty standard stuff) but I don't think any of those sort of documents prohibit a release of medical records. It's a shame that the doctor is making you jump through hoops but if he continues to stonewall you it might make me wonder what he is afraid you might see.
Rob
derek_m rob78162
Posted
Thanks for the info. Yeah I am surprised and alarmed at his refusal to send the report. I am in the US and was going to hit up a lawyer friend to send the letter but maybe I call his office first and see what they say.