National Institute for Health and Clinical Excellence (NICE)
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NICE consults on plans to support new device which avoids surgery for enlarged prostate glands

A new device that aims to relieve the urinary tract problems caused by enlarged prostate glands in men is the focus of NICE draft guidance that opened for the consultation yesterday (Friday 29 May).

NICE is asking for views on its draft medical technology guidance – which provisionally recommends the use of the UroLift system for treating the symptoms of benign prostatic hyperplasia, when the device is used in a day surgery unit.  An enlarged prostate can push against the urethra, making it difficult for a man to pass urine. Using the UroLift system involves inserting implants to move the excess prostate tissue away from the urethra, which stops the extra tissue blocking the flow of urine.  The system avoids the need for surgery or cutting away the extra prostate tissue, which are the methods commonly used to treat a urine blockage caused by an enlarged prostate.

The UroLift system should be considered for men aged 50 years or older with urinary tract symptoms, where the size of their prostate is less than 100cm3. The claimed benefits of the system include preserving sexual function, fewer follow-up visits and reduction in the length of hospital stay because treatment with UroLift can be carried out as a day procedure. The draft guidance estimates that savings of up £336 per patient could be made using this system when compared with other treatments.

Prostate enlargement is a common condition in older men – around 60% of men aged 60 or over have some degree of prostate enlargement. Along with difficulties passing urine, an enlarged prostate gland blocking the urine tract include may lead to severe urinary tract infections, urinary retention or renal failure, but the condition doesn’t pose other direct risks to health.  If drug treatment and conservative management options have been unsuccessful or are not appropriate, then surgery is offered when problems passing urine are severe.   

Professor Carole Longson MBE, Director of the NICE Centre for Health Technology Evaluation, said: “As men get older many may develop an enlarged prostate gland which can lead to problems in passing urine, and other urinary tract symptoms.  This draft guidance on the UroLift system provisionally supports the use of this device for men over 50 years old with urinary tract symptoms, when performed as a day case. The evidence examined by the independent Medical Technologies Advisory Committee indicates that as well as benefiting patients by avoiding surgery, it protects sexual function, and it’s also likely to benefit the NHS by saving money.  We welcome comments on the draft guidance as part of this consultation.”

More information on the medical technology draft guidance consultation for the UroLift system  is available athttp://www.nice.org.uk/guidance/indevelopment/gid-mt241. The consultation closes on 26 June 2015. 

For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142, or out of hours on 07775 583 813.

Notes to Editors

About the NICE guidance

1. The draft medical technologies guidance, “UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia”, is available at http://www.nice.org.uk/guidance/indevelopment/gid-mt241 as of Friday 29 May. Embargoed draft guidance is available from the NICE press office.

2. The UroLift system is manufactured by NeoTract.

3. The cost of the UroLift system (comprising 1 delivery device and 1 implant) stated in the company’s submission is £330 (excluding VAT). An average of 4 implants is used for each procedure so the typical per-patient cost is £1320.

4. Cost modelling estimates that using the UroLift system in a day surgery unit results in cost savings of around £336 and £209 per patient compared with monopolar and bipolar transurethral resection of the prostate (TURP) respectively, and incurs extra costs of around £40 per patient compared with holmium laser enucleation of the prostate (HoLEP). The primary cost driver in the modelling is the unit cost, and number of implants used per treatment. Approximately 15,000 prostate resection procedures (such as TURP and HoLEP where prostate tissue is cut away) are carried out each year in England and Wales.

5. NICE issued guidance supporting the procedure of inserting prostatic urethral lift implants (such as the UroLift system) to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia in January 2014:http://www.nice.org.uk/guidance/ipg475.

6. NICE issued guidance supporting the use of the TURis system for transurethral resection of the prostate (a bipolar electrosurgery system to cut away or vaporise excess prostate tissue) in February 2015:http://www.nice.org.uk/guidance/mtg23.

About the Medical Technologies Evaluation Programme

7. The Medical Technologies Evaluation Programme focuses specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions. The independent Medical Technology Advisory Committee has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. The guidance applies to the NHS in England, and is not mandatory.
More information is available at http://www.nice.org.uk/MT.

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