NICE Consults on Enlarged Prostate Gland Solution

UK health watchdog NICE is asking for views on its plans to support a new surgical system for reducing the size of enlarged prostate glands in men.

Background

The UK’s National Institute for Health and Care Excellence (NICE) exists, at least in part, to guide medical professionals in certain aspects of the everyday lives. Its recommendations are considered sign-offs, often on new technologies, the aim being to do the legwork of establishing cost/benefit relationships so individuals and hospitals don’t have to. Sometimes the legwork comes in the form of consultation exercises.

This newly announced consultation opens on Weds 8 October and closes on 5 November 2014.

Prostate enlargement is a common condition in older men – around 60% of men aged 60 or over have some degree of prostate enlargement. The enlarged prostate gland may press on the urethra and so can make passing urine more difficult. The condition doesn’t pose other direct risks to health, but complications of a blocked urine tract include severe urinary tract infections, urinary retention or renal failure. Surgery is offered when problems passing urine are severe, or if drug treatment and conservative management options have been unsuccessful or are not appropriate. Approximately 15,000 prostate resection procedures are carried out each year in England and Wales.

NICE draft medical technology guidance provisionally supports the use of the TransUrethral Resection in saline (TURis) system. This device, which is similar to an endoscope with a diathermy wire in front of the camera, uses a bipolar electrosurgery system to cut away or vaporise excess prostate tissue. Using the TURis system reduces the need for blood transfusion, and the length of hospital stay and rates of hospital readmission may also be reduced. The device also eliminates TUR syndrome – a rare but serious complication of prostate resection, which can occur with monopolar electrosurgery. The draft guidance estimates that savings of up £375 per patient could be made using this system.

In electrosurgery, the tool that the surgeon uses to cut tissue has an electric current running through it which seals the cut and so reduces bleeding. To complete the electrical circuit, a return electrode is needed. The TURis system’s bipolar design has an internal return electrode within the device which means that a return electrode does not need to be stuck onto the patient’s skin. Also, unlike monopolar electrosurgery, the bipolar TURis system doesn’t use glycine to flush out blood and debris from the urethra, which therefore avoids any risk of a problem called TUR syndrome.

NICE comments

Professor Carole Longson, Director of the NICE Centre for Health Technology Evaluation, said: “The problems caused by an enlarged prostate gland affect many men as they get older. The supportive provisional recommendation for the TURis system advises that it should be considered for use in patients where surgery is needed because of severe symptoms associated with an enlarged prostate. The evidence examined by the independent Medical Technologies Advisory Committee indicates that as well as benefiting patients by reducing the need for blood transfusion, it’s also likely to benefit the NHS by saving money. We welcome comments on the draft guidance as part of the current consultation.”

More information on the medical technology draft guidance consultation for the TURis system is available here.

Source: NICE

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