Many men with benign prostatic hyperplasia (BPH) worry about how treatment might affect their sexual health. UroLift is a minimally invasive procedure that relieves urinary symptoms by mechanically lifting enlarged prostate tissue away from the urethra, without cutting, heating, or removing tissue. Recommended by NICE (MTG26) for selected men with moderate to severe symptoms, UroLift preserves prostate anatomy and has a favourable sexual function profile compared to traditional surgical options. Whilst it does not directly treat erectile dysfunction, understanding the relationship between BPH treatments and sexual health is essential for informed decision-making. This article examines the evidence on UroLift and erectile function, helping you understand what to expect.

What Is UroLift and How Does It Work?

UroLift is a minimally invasive surgical procedure designed to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. The UroLift system is a CE/UKCA-marked medical device, and NICE (Medical Technologies Guidance MTG26) recommends it as a treatment option for selected men with moderate to severe urinary symptoms due to BPH when surgical intervention is appropriate and who have not responded adequately to conservative management or medication.

The UroLift system works by mechanically lifting and holding the enlarged prostate tissue away from the urethra, creating a wider channel for urine to flow through. During the procedure, which is typically performed under local anaesthesia with sedation, small permanent implants are placed through the urethra using a specialised delivery device. Each implant consists of a nitinol capsular tab, a stainless steel urethral end-piece, and a permanent suture that compresses the obstructing prostate lobes without cutting, heating, or removing any tissue.

Key features of UroLift include:

• Preservation of prostate tissue and anatomy

• No requirement for general anaesthesia in most cases

• Typically performed as a day-case procedure

• Symptom improvement often within 2–4 weeks, continuing over three months

• Lower risk of sexual side effects compared to traditional surgical interventions such as TURP

The procedure usually takes 10–30 minutes to complete. Many men go home the same day without a catheter, though some may require a short-term catheter for 1–3 days depending on individual circumstances. Unlike transurethral resection of the prostate (TURP) or laser ablation procedures, UroLift does not involve tissue removal or thermal energy, which reduces the risk of damage to nerves and structures important for sexual function.

UroLift is not suitable for everyone. NICE MTG26 recommends careful patient selection, and eligibility criteria may include prostate volume limits and consideration of obstructive median lobe anatomy. Your urologist will assess your suitability through clinical examination (including digital rectal examination), symptom scoring (International Prostate Symptom Score, IPSS), urine flow studies, post-void residual volume measurement, and PSA testing as indicated. This tissue-preserving approach has made UroLift a suitable option for many sexually active men concerned about maintaining erectile and ejaculatory function whilst addressing bothersome urinary symptoms.

How BPH Treatments Affect Sexual Function

Understanding the relationship between BPH treatments and sexual function is essential for informed decision-making. Traditional medical and surgical interventions for BPH can significantly impact various aspects of male sexual health, including erectile function, ejaculation, and libido.

Medical therapies commonly prescribed for BPH include alpha-blockers (such as tamsulosin, alfuzosin) and 5-alpha reductase inhibitors (finasteride, dutasteride). Alpha-blockers generally have minimal impact on erectile function but can cause ejaculatory disorders in a proportion of men, including reduced ejaculate volume or anejaculation; true retrograde ejaculation (where semen enters the bladder) may also occur. According to UK Summaries of Product Characteristics (SmPCs), ejaculatory disorders occur in approximately 4–11% of men taking alpha-blockers, depending on the specific agent and dose.

5-alpha reductase inhibitors carry a higher risk of sexual side effects. The MHRA has issued Drug Safety Updates acknowledging reports of persistent sexual side effects, including erectile dysfunction, reduced libido, and ejaculatory dysfunction, which may continue even after stopping the medicine. SmPCs for finasteride and dutasteride report erectile dysfunction in approximately 5–9% of users, reduced libido in 3–5%, and ejaculatory disorders in 2–7%. Men considering these medicines should discuss these risks with their GP or urologist.

Surgical interventions traditionally used for BPH, such as TURP, carry substantial risks to sexual function. Retrograde ejaculation occurs in approximately 65–75% of men following TURP, whilst erectile dysfunction develops in around 6–10% of cases, though rates vary by technique and centre. Newer laser procedures, including holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), show similar rates of retrograde ejaculation but may have slightly lower rates of erectile dysfunction in some studies.

The mechanisms underlying these sexual side effects vary by treatment modality. Tissue removal or thermal damage during surgery can affect the bladder neck, prostatic urethra, and surrounding neurovascular structures critical for erectile and ejaculatory function. Medical therapies alter hormonal pathways or smooth muscle tone, which can impact sexual response. This context makes tissue-preserving approaches like UroLift worth considering for men prioritising sexual health alongside symptom relief, though individual circumstances and preferences should guide treatment choice.

What to Expect After UroLift: Sexual Health Outcomes

Clinical evidence regarding sexual function outcomes following UroLift has been extensively studied, with several randomised controlled trials and long-term follow-up studies providing reassuring data for men concerned about maintaining sexual health.

The landmark L.I.F.T. study (Luminal Improvement Following UroLift Treatment), a multicentre randomised controlled trial comparing UroLift to sham surgery, demonstrated preservation of sexual function using validated assessment tools. At 12 months post-procedure, there were no clinically significant changes in erectile function scores, and importantly, ejaculatory function was maintained in the vast majority of participants. The rate of new-onset erectile dysfunction was comparable between the UroLift and control groups, suggesting the procedure itself does not directly cause erectile problems.

Long-term data extending to five years post-procedure confirm these findings, with sustained preservation of both erectile and ejaculatory function. Studies report very low rates of new erectile dysfunction attributable to the UroLift procedure itself, and retrograde ejaculation—which is nearly universal after TURP—occurs in only a small minority of UroLift patients (approximately 2–4% in published series).

Common post-procedure experiences include:

• Temporary dysuria (painful urination) lasting 1–2 weeks

• Haematuria (blood in urine) for several days

• Increased urinary frequency or urgency initially

• Pelvic discomfort resolving within 2–4 weeks

• Occasional urinary retention requiring temporary catheterisation

Less common but important risks include:

• Urinary tract infection

• Bleeding with clots

• Implant migration or encrustation

• Urethral stricture

• Need for further intervention or re-treatment

Most men notice improvement in urinary symptoms within 2–4 weeks, with continued improvement over three months. Sexual activity can typically resume when you feel comfortable and any bleeding or pain has resolved, usually within 1–2 weeks, though individual recovery varies. Your urologist will provide specific advice based on your recovery.

Seek urgent medical attention if you experience:

• Fever or signs of infection

• Inability to pass urine

• Severe or persistent heavy bleeding or large clots

It is important to note that whilst UroLift preserves existing sexual function, it does not enhance or restore function that was already impaired before the procedure. Men should have realistic expectations and discuss their baseline sexual function with their urologist prior to treatment. If you experience any suspected side effects from the UroLift device or any medicine, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Does UroLift Help Erectile Dysfunction?

The direct answer to whether UroLift helps erectile dysfunction is clear: UroLift does not directly treat or improve erectile dysfunction. The procedure is specifically designed to relieve urinary obstruction caused by BPH, not to enhance erectile function. There is no established mechanism by which the mechanical lifting of prostate tissue would improve the physiological processes underlying erections.

However, some men do report subjective improvements in sexual satisfaction following UroLift, which can be explained by several indirect factors. Firstly, the relief of bothersome urinary symptoms—such as frequent nighttime urination, urgency, and weak stream—can significantly improve quality of life, reduce anxiety, and enhance overall wellbeing. This psychological benefit may translate into improved sexual confidence and performance. Secondly, men who are able to discontinue BPH medications with sexual side effects (particularly 5-alpha reductase inhibitors) after successful UroLift—under the guidance of their clinician—may experience recovery of sexual function previously suppressed by those drugs.

Important considerations include:

• Erectile dysfunction and BPH often coexist due to shared risk factors (age, diabetes, cardiovascular disease, metabolic syndrome, smoking, obesity, physical inactivity)

• Treating BPH does not address the underlying vascular, neurological, or hormonal causes of erectile dysfunction

• Men with pre-existing erectile dysfunction should seek appropriate evaluation and treatment from their GP or a specialist

• Phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil) remain the first-line treatment for erectile dysfunction and can be used safely after UroLift, though they are contraindicated in men taking nitrates for angina

If you are experiencing erectile dysfunction alongside urinary symptoms, it is essential to discuss both concerns with your healthcare provider. A comprehensive assessment may include cardiovascular risk evaluation (as erectile dysfunction can be an early marker of cardiovascular disease), hormone testing (testosterone levels), and consideration of psychological factors. NICE guidance recommends addressing modifiable risk factors such as obesity, smoking, and physical inactivity, which impact both conditions. Your GP may refer you to a specialist if first-line treatments are ineffective or if there are complex underlying causes.

UroLift offers a suitable option for managing BPH whilst preserving sexual function, but separate, evidence-based treatments should be pursued for erectile dysfunction itself. If you notice new or worsening erectile problems after any BPH treatment, contact your GP for further evaluation and management.

Frequently Asked Questions