BlueCross BlueShield of Tennessee Medical Policy Manual

Prostatic Urethral Lift


The prostatic urethral lift procedure (e.g. UroLift®) involves the insertion of one or more permanent implants into the prostate, which retract prostatic tissue and maintain an expanded urethral lumen. This procedure can be done with minimal sedation and is often performed in the office setting.

Benign prostatic hyperplasia (BPH) is a common disorder among older men that results from hyperplastic nodules in the periurethral or transitional zone of the prostate. The normal prostate size for an adult male is 15cc to 30cc (one half ounce to one ounce). BPH prevalence increases with age and is present in more than 80% of men aged 70 to 79. The clinical manifestations of BPH include increased urinary frequency, urgency, nocturia, hesitancy, and weak stream. The urinary tract symptoms often progress with worsening hypertrophy and may lead to acute urinary retention, incontinence, renal insufficiency, and/or urinary tract infection.

Evaluation and management of BPH includes evaluation for other causes of lower urinary tract dysfunction (e.g., prostate cancer). Symptom severity determines the therapeutic approach. Therapies available include oral medications, surgical ablative procedures, or transurethral resection of the prostate (TURP).





Two scores are widely used to evaluate BPH-related symptoms: the American Urological Association Symptom Index (AUASI); and the International Prostate Symptom Score (IPSS). The AUASI is a self-administered seven-item questionnaire assessing the severity of various urinary symptoms. Total AUASI scores range from 0 to 35, with overall severity categorized as mild (≤7), moderate (8-19), or severe (20-35).The IPSS incorporates questions from the AUASI and a quality of life question or a “Bother score.”


American Urological Association. (2018, May) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. Retrieved November 15, 2018 from 

BlueCross BlueShield Association. Evidence Positioning System. (8:2018). Prostatic urethral lift (7.01.151). Retrieved November 15, 2018 from (37 articles and/or guidelines reviewed)

Chin, P., Bolton, D., Jack, G., Rashid, P., Thavaseelan, J., Yu, R., et al. (2012). Prostatic urethral lift: two-year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology, 79 (1), 5-11. Abstract retrieved September 28, 2016 from PubMed database. Center for Medicare & Medicaid Services, Palmetto GBA. (2018, July). Minimally invasive treatment for benign prostatic hyperplasia involving prostatic urethral lift (Urolift®) (LCD ID: L36109). Retrieved November 15, 2018 from

ECRI Institute. Emerging Technology Evidence Report. (2017, April). Implantable transprostatic tissue retractor system (UroLift) for treating benign prostate hyperplasia. Retrieved July 7, 2017 from ECRI Institute. (127 articles and/or guidelines reviewed)

Gratzke, C., Barber, N., Speakman, M., Berges, R., Weterauer, U., Greene, D., et al. (2017). Prostatic urethral lift vs transurethral resectin of the prostate: 2-year resuls of the BPH6 prospective, multicentre, randomized study. BJU International, 119 (5), 767-775. (Level 2 evidence)

McNicholas, T. A., Woo, H. H., Chin, P. T., Bolton, D., Fernández, A. M., Sievert, K. D., et al. (2013). Minimally invasive prostatic urethral lift: surgical technique and multinational experience. European Urology, 64 (2), 292-299. Abstract retrieved September 28, 2016 from PubMed database.

McNicholas, T. A. (2016). Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system. Medical Devices: Evidence and Research, 9, 115-123. (Level 2 evidence)

National Institute for Health and Care Excellence. (2015, September). UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia. Retrieved October 23, 2015 from  

National Institute for Health and Care Excellence. (2014, January). Insertion of prostatic urethral lift implants to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia. Retrieved July 7, 2017 from

Neotract. (2018, January) UroLift® Systems UL400 instructions for use. Retrieved February 28, 2019 from

Perera, M., Roberts, M. J., Doi, S. A. & Bolton, D. (2015). Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systemic review and meta-analysis. European Urology, 67 (4), 704-713. Abstract retrieved September 28, 2016 from PubMed database.

Pushkaran, A., Stainer, V., Muir, G., and Shergill, I. (2017, March) Urolift - minimally invasive surgical BPH management. Expert Review of Medical Devices, 14(3), 223-228. Abstract retrieved January 5, 2018 from PubMed database.

Roehrborn, C. G., Barkin, J., Gange, S. N., Shore, N. D., Giddens, J. L., Bolton, D.M., et al. (2017). Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Canadian Journal of Urology, 24 (3), 8802-8813. (Level 2 evidence)

Rukstalis, D., Rashid, P., Bogache, W., Tutrone, R., Barkin, J., Chin, P., et al. (2016). 24-month durability after crossover to the prostatic urethral lift from randomized, blinded sham. BJU International, 118 (3), 14-22. (Level 2 evidence)

Sánchez-Gómez, L. M., Polo-deSantos, M., Gómez-Sancha, F., & Luengo-Matos, S. (2015). Efficacy and safety of the UroLift® system for the treatment of benign prostate hyperplasia symptoms: systematic review. Actas Urologicas Espanolas, 39 (5), 311-319. Abstract retrieved September 28, 2016 from PubMed database.

Sønksen, J., Barber, N., Speakman, M., Berges, R., Wetterauer, U., Greene, D., et al. (2015). Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. European Journal of Urology, 68, 643-652. (Level 2 evidence)

U. S. Food and Drug Administration. (2017, December). Center for Devices and Radiologic Health. 510(k) Premarket Notification Database. K173087 (UroLift®). Retrieved February 19, 2019 from

Winifred S. Hayes, Inc. Health Technology Brief. (2016, July, update November 2018). UroLift System (NeoTract Inc.) for treatment of benign prostatic hyperplasia. Retrieved February 19, 2019 from (33 articles and/or guidelines reviewed)

Woo, H., Chin, P., McNicholas, T., Gill, H., Plante, M., Bruskewitz, R., et al. (2011). Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BJU International, 108, 82-88. (Level 4 evidence)




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