Removal of urolift clip? Advice and experiences

Men's health
1

I had 3 urolift clips implanted 2 years ago for a bladder problem, followed by a bladder neck resection neither of which solved the issue. As a result I’ve been self catheterising ever since, but have suffered constant UTI’s - at least once per month, sometimes every couple of weeks for which I’ve taken a cocktail of antibiotics.

A urologist recently did a cystoscopy and discovered that one of the urolift clips has been implanted in the wrong place - too far up in the bladder neck and sticks out attracting bacteria. As a result tissue has never healed over the clip and he is convinced the fact the clip is exposed is the cause of the repeated infections.

Ok, so I ask him to remove the offending clip (the urolift website claims this is a simple procedure) but was shocked when he said that due to its location the clip can only be removed by performing a TURP which will cause RE.

Has anyone had experience of having a urolift clip (that was located in the bladder neck) removed?

2

Thanks for the info. Before my “failed Urolift” my Urologist told me he could remove the clips which at the time I should have ask him what are the situations where they would needed to be removed. He also told me that they had stopped placing them close to the Bladder neck because sometimes they would penetrate the Bladder. When I went back about a month ago complaining about it not helping my flow and that I had a strange sensation in that area. He said that maybe one had penetrated the Bladder, however, he did not find a problem after performing a Cystocospy.
I will be going back in August and will be asking him to remove the clips for me. I suspect he will want to perform a TURP after removing the clips but that want happen. I may have to find another Urologist that will remove the clips for me. Of course I realize that only the clips in the Urethra can be removed and not the sutures and clips in the prostate without surgery.

3

I have continual low-level pain after Urolift 9 months ago. 3 clips were placed around the bladder neck to try and deal with a median lobe pushing up on the bladder neck. 2 further clips to pull the prostate apart (more standard use of Urolift).
Where exactly does the other end of the Urolift clip end up? I am wondering, in my case whether one has gone too far as my prostate is very small at 28g and presumably these clips are designed to fire off for much longer distances through large prostates?
A recent cystoscopy revealed no ends in the bladder thankfully but the Uro wasn’t inclined to check for anything else and said it would heal over. hmm no one mentioned months of pain as a possible side-effect of urolift.
Yes the Urolift site claims it is reversible but it cant be that easy to cut off the head in the Urethra which is under tension and surrounded by flesh. Neither does that address the suture or the other end of the clip which are pretty much there for good now.
I am sorry you are faced with a TURP. Its the same for me as the Urolift has not solved my problems so I need a TURP to deal with the median lobe/raised bladder neck but have at least a 6 month wait on the NHS.

4

Sounds like me and I hope my Urologist will agree to remove the clips in the Urethra. I will not have a TURP but focus on using drugs and possible something Lazer or wait for something new. I want to just get back to where I was before the Urolift, better flow but some Bladder problem.

5

Just had two clips removed a few weeks ago that were sticking into my bladder causing bleeding issues and forming a stone. Had a partial TURP to remove the offending clips but he left the remaining 4 clips in place. I have not had RE and I pee a lot better now. The surgery was with general anesthesia and I had a catheter for a day which made it a lot nicer than the horrendously painful Urolift procedure with a little numbing gel and a nurse to hold my hand while I screamed. I feared the TURP and maybe being only a partial TURP to remove the clips, I got lucky.But its better than peeing blood after every workout.

6

Hey Ben that’s great that things have improved for you and no RE too. Any idea how the clips got into the bladder? Is that a normal risk or was the Uro inexperienced?
Can I ask, was it a standard hot wire TURP cutter used for your partial TURP? I am also facing a part TURP after my failed Urolift. The Uro says he can use the wire loop to slice away the problem median lobe and would be more accurate than laser for this job.

7

OK I see the answer ref. the clips in your other posts.
Be interested to know whether the part TURP was laser or hot wire? Did they trim down the median lobe for you?

8

I also have a small prostate (30g) and the problem for me seems to be that one of the clips was positioned too close to/in the bladder neck and as a result sticks out, is not covered in mucosa and is therefore the source of my repeated infections. I’m currently researching Doctors to approach who may be able to remove the offending clip without resorting to a TURP.
During the cystoscopy that identified the incorrectly located clip a video was taken - do I as the patient have the right to request a copy of the video or is this the sole “property” of the doctor? And if the answer to the first question is yes I can request a copy, then would this likely be sufficient for another surgeon to form an opinion on whether the clip could be removed without performing a TURP?

9

I was told that TURP was the only way to get the clips out, that is how they cut the suture. It would be nice to know if there are other options after the clips have been in for awhile. You should be able to get a copy of the video to get a second opinion. I went to another doctor that does Urolift because I thought he would be better at knowing how to get them out. I assume in their training they get trained on that part as well.I found very little information on having clips removed so if you learn anything new, please share. I have 4 remaining clips, so far they seem to be fine but if they give me trouble down the road, I would like to know best practices for removal

10

Thanks for you info. I have 5 clips that were installed in March and I want every one of them removed because it has made my flow worse and I have a constant unpleasant felling in that area. I had a Cystocopy a month ago and he said no clips were in the bladder and that things looked good. I observed the Cystocospy and I saw folds or puckers that I think has made my flow worse.
My Urologist told me before he installed the clips that he could remove them. In August I have an appointment with him and I am going to ask him to remove all of them. I am determined to not let him perform a TURP but I suspect that is the only way he will agree to remove them, and I wonder if insurance will pay for removing something that just did not work but made things worse. I will give feedback on my attempt to get the damn things removed. Hope I can get back my flow to where I was so I can concentrate on an overactive bladder using medicine.

11

I have BPH issues for a long time due to a nodule in my prostate. About 5 years ago my URO implanted 5 to 6 clips. They worked fine until three months back during which I had 3 UTI issues. Following a cystoscopy, he tells me that a pin located in prostate is causing these infections. He also says that there is calcification around the pin. He told me that the pin is not in the bladder which would be hard to remove. He is going to remove the pin on Friday. In spite of his diagnosis, my concern still is about TURP . Can he perform TURP in the same procedure?

12

In 2019 I had the Rezum and the Urolift (8 clips)
This year I had to have a TURP because the others didn’t work.

13

I’m not aware of a procedure to remove the urethral tab and however much of the suture without removing the surrounding tissue - i.e., resection of some sort.

I think anyone with a median lobe who would consider having their uro tack it to the side using the Medlift variant of the procedure is nuts. Way too many cases of just regular implants being shot into the bladder because they were placed too high.

I had 5 implants in 2016 that provided decent relief for 18-24 months before I had to start looking for a more aggressive treatment. I ended up having Aquablation done last September which worked out very well. My surgeon said he only found 3 of the 5 Urolift urethral tabs (all were long ago grown over by new epithelial cells). He said the other two almost surely had broken loose during the waterjet ablation and been irrigated out and not noticed as the water jet created a huge cavity out to the surgical capsule that would have exposed them.

As for the concerns about having to get a TURP to have the clips removed, I suspect that would be the easiest way. If you’re concerned about the RE likelihood with a TURP then find a surgeon who does modified TURPs that leave 5-10 mm of tissue proximal to the veru and is very cautious about removing tissue elsewhere in the apex. This is where the structures critical to maintaining antegrade ejaculation are. It won’t matter what he/she resects proximal to that 5-10 mm slab of tissue that forms the so-called ejaculatory hood. If an intravessical median lobe is your main problem then it is easy for a good surgeon to resect that part of the ML with a loop but they have to be careful to not dig too close to veru at 6 o’clock, as if they get too close to it they’ll hit the main ejaculatory ducts.

14

Hey Buddy

Sorry that you are have that problem. He should be able to cut the string and remove the one clip. The anchor will be left but that should not bother you.

Tell him no way to the Turp. If he will not do what you want find one that will. You don’t want retro ejaculation which if you have a Turp you will get.

They do not have to so a Turp to remove what needs to be removed

Be safeKen

15

Hey Buddy

Sorry that the Urolift did not do what you need for longer. I had mine done over 7 years ago and I am still wide open.The anchor cannot be remove but the string and the clip can. This will release the tissue.

Aquablation is just another way of doing a Turp just with water. Did they ever fix the bleeding problem. Sis you end up with retro and are they able to a just it now. I know before there was no way to a just it and everything was taking out.

I have talked to me that have had it done and it did work but after 6 month’s they went dry which they were not happy.

Good luck to you and I hope it is what you hope it is. Ken

16

Hi Ken. If you’ll carefully read what I wrote above you’ll see that I said there’s not a way to remove the urethral end piece and the PET suture without resecting tissue. The urethral end piece becomes covered with tissue over time and embedded in the lobe. Therefore, at least some tissue would have to be removed to gain access to the urethral end piece unless it is removed before the end piece is invaginated. If the surgeon is unsure of the location of the urethral end piece, you can understand that a significant amount of tissue may have to be removed to locate it. Obviously, only that portion of the PET suture to which the surgeon has access can be removed.

Other than Urolift and possibly iTIND, every BPH procedure in existence is “just another way of doing TURP” if by that you mean removing abnormal tissue that is obstructing. The bleeding issue you mention was primarily an issue in the larger prostates (80-150 ml) in the WATER II trial. Dr. Dean Elterman published a paper last month in the Canadian Journal of Urology in which it was shown that the transfusion rate was 0.8% in the 2,000+ aquablation procedures performed globally between late 2019 and early 2021 by 170 different surgeons. This rate is generally comparable with the transfusion rates for GL-PVP and HoLEP and superior to TURP and prostatectomies. This analysis included aquablations performed on prostates up to 363 ml in size (mean volume or 87 ml which is relatively large for BPH patients). 88% of the transfusions that were required occurred with surgeons who had performed 5 or fewer aquablations. Bottom line, bleeding is a nothingburger with aquablation today.

I have had no sexual side effects. The data from the RCTs for aquablation show that the likelihood for RE increases with prostate volume but typically is less than 10%. I would be careful about drawing conclusions (either positive or negative) from anecdotal information you read from a small number of patients here. It is wildly inaccurate to extrapolate results from a handful of cases when thousands of them are done. You should also keep in mind that results from aquablation procedures depend on what ablation contours are selected by the surgeon. They are not all the same – the surgeon determines what to remove. Also, I would expect to see RE percentages decline over time as more is learned about the root cause. There was another paper published earlier this year in which the investigators retrospectively analyzed stored ultrasound video files from prior aquablation cases in an attempt to correlate surgical parameters set by the surgeon with higher rates of RE. They assessed several anatomical parameters statistically and found higher odds ratios when comparing the RE group versus the non-RE control group when two things occurred. Those were when the ejaculatory ducts were affected (no surprise), and when the cut below the top of the verumontanum was deeper than 5 mm. This cut is referring to the cuts lateral to the veru, not on the veru itself. So as lessons like that are learned the side effect profile will only improve.

I don’t know what you mean by “are they able to adjust it now and before there was no way to adjust it and everything was taken out.” It sounds like you’re confused or misinformed.

I’ve read anecdotal accounts of rezum patients who had late onset RE. This is believable since the tissue is not removed during the procedure, it dies and the cavity is formed over time. A late onset RE scenario is much less believable in those who’ve had aquablation surgery in which the structures critical to antegrade ejaculation are preserved. There is no subsequent necrosis process in that case. What’s gone immediately after the surgery is the same as what’s gone 6 months later. The surfaces that were ablated heal as a new epithelial layer of tissue is formed over a course of several months. My surgeon told me some of his patients don’t care about RE and just want to pee as well as they can so he uses more aggressive ablation contours in their cases. So some patients who have RE following aquablation have it because there was no attempt by the surgeon to avoid it. You should not equate those scenarios to “aquablation causes RE.”

17

Hey there Russ

Thank you for the reply. So I guess they have improved it some over the years. The information that I was talking about came from a Neil Barber He did the trail before he brought it to the US

I still have his emails. This is the one he sent to me in August of 2018 when I ask him about adjusting the water and what is taking out.

I’m afraid the planning is in real time when your asleep. You can’t identify the prostatic or common ejaculatory ducts I’m afraid. But you could plan to be conservative at the bladder neck and where the ducts emerge in the hope for higher rates. But that is as far as it goes.

If you want a procedure that is 100% all sexual function then Urolift is the only option. Good data behind it.

At the time of the trails it was 10 to 20 % For me that is to much of a risk. I’m happy that you are happen men can pick what every that want. It is up to them

Take care and be safe,Ken

18

Of course it’s been improved, it was a novel application of a technology to prostate disease 7 years ago when they did initial tests on canine prostates. It didn’t have FDA approval to be marketed until late 2017.

What do you mean by “…he brought it to the US?” Are you saying Barber told you he brought the technology to the US? I’ve read all of the US patents related to aquablation and don’t recall seeing his name among the inventors or assignees. He was one of many urologists from several countries who participated in the WATER trial. The Aquabeam system evolved from inventions assigned to a company in Massachusetts in which products using water jets used in spinal surgery and possibly other applications were developed.

Regarding his comments in the email he sent you:

“I’m afraid the planning is in real time when your asleep.”

I don’t know what question this was in response to, but all he is saying is that the patient is under anesthesia before the surgeon begins his work. No kidding!!! However that does not mean the surgeon and patient do not discuss and agree on the general approach the surgeon will take when setting the ablation contours during office visits. That was certainly true in my case. In fact it was one of the first things he asked me.

“You can’t identify the prostatic or common ejaculatory ducts I’m afraid. But you could plan to be conservative at the bladder neck and where the ducts emerge in the hope for higher rates.”

You can easily see where the ducts emerge on the veru with the scope that is part of the handpiece instrument and most experienced urologists should know the approximate path the main ejaculatory ducts take from the seminal vesicles which are visible on the ultrasound. They typically run posterior laterally and angle toward the veru from below. Given the position of the hand piece probe that contains the water jet aperture (pressed up against the anterior surface of the urethra) and that the maximum cut depth is 25mm (~2.5cm) the water jet is not capable of reaching the depth where the ejaculatory ducts run except in the apex where they approach and enter the veru from below on all but the smallest prostates. This is why the software contains an adjustable veru protection zone that limits the sweep angle of the jet so that it cannot go below 52 degrees on either side resulting in the so-called “butterfly cut” and also why the surgeon can raise the cut profile in the sagittal plane to limit the maximum cut depth anywhere along the axis of the probe.

Responding to your previous comment “before there was no way to adjust it and everything was taken out.”

This is simply not true. The WATER trial (in which he participated) and the FDA approval of the device were started / granted prior to 2018 when you got that email from him. The documentation for both explains how the ablation contours are adjustable. If they were not adjustable then the system could only be used on one size/shape/configuration of a prostate, which is preposterous. I don’t know what you mean by “everything” but that is not true either. In fact, it’s not POSSIBLE in prostates above a fairly small size. The water jet has limits on maximum sweep angle and cut depth. It can’t ablate anything outside of that envelope unless the hand piece is repositioned following the first cut which I’ve never heard of being done.

I think you’ve also claimed before that once the robot starts a resection pass it can’t be stopped or changed until it finishes. That also is untrue. The system as described in the 2017 FDA document includes a foot switch that starts the resection when depressed and halts it when lifted. In the conformal planning unit video from my procedure that I’ve watched multiple times it is obvious that not only is it possible to stop and end a pass before it’s completed, my surgeon did that to make some adjustments during one of the two passes.

Urolift has two things going for it. It never causes sexual side effects (unique in that regard) and it can be done in-office without general or spinal anesthesia. However it does have some risks other procedures don’t and on average is not as effective as procedures that remove tissue. I’m glad it met your goals in your case but that’s not a reason to criticize other procedures that are available to men who likely are not as worried about RE as you seem to be and may have different goals.

19

When you say it was in the bladder neck, do you mean the urethral end piece or the capsular tab, or both? If it is the former and the latter is not causing an issue (i.e., it is external to the prostate capsule/bladder neck/bladder wall), I don’t understand why he would have to perform a comprehensive TURP to remove the urethral end piece that is exposed. After all, it’s exposed and he can see it, right? Removing some tissue in the vicinity of the urethral end piece to aid in cutting the suture, while technically a “TURP,” would be unlikely to cause RE.

There is another scenario where the urologist deploys the needle to near the bladder neck and because it deploys upward (proximally) on a curved trajectory, it may puncture the bladder wall and deploy the capsular tab inside the bladder.

20

For one I’m not criticizing other procedures I have many friends that have had Holep and Turps and EP Sparing Plasma Turps. If that is what you decide then that is what you have.

I just was telling you what I was told 3 years ago. I know about the foot pedal.

And there are many men no matter how old that they still feel that they want there ejaculation. I know men that are in there 70’s that are still having sex and feel that there ejaculation goes with there orgasm and will not get rid of it for any reason

I do not feel that any prostate procedure should be done in the office. That is a insurance thing. I had mine when it first came out in a surgery center

I hope you have a great day …Ken