A minimally invasive treatment for enlarged prostate

Mr Hrishi Joshi, Consultant Urological Surgeon and Honorary Lecturer


Cardiff and Vale University Health Board


This Bevan Exemplar Project introduced UroLift as a minimally-invasive treatment for urinary tract symptoms from benign prostatic hyperplasia (BPH).


Background


In men over the age of 50, around 1 in 3 have urinary symptoms. This is most commonly caused by an enlarged prostate, known as benign prostatic hyperplasia (BPH).


Men with moderate or severe symptoms are offered highly invasive surgical procedures; transurethral resection of the prostate (TURP) – cutting away or removing existing tissue.


Traditional surgical treatments pose a considerable burden on healthcare resources; pressures on bed availability and risk of cancellation; along with posing risks of post-operative complications (sexual, continence) and delayed recovery.



UroLift is a new, 20 minute, minimally-invasive, day case treatment alternative to surgery; lifting and holding the enlarged prostate tissue so it no longer blocks the urethra.


UroLift offers many benefits in a suitable patient population including rapid symptom relief with durable results and quality of life benefits to patients.


Aims

  • The aim is to pilot the new service of this minimally invasive treatment for patients with BPH at the University Hospital of Wales.

  • Devise and implement a local service plan by applying to 20-30 patients in a year.

  • Run a prospective service evaluation audit.

  • Feedback early results – presentation to the key stakeholders.

  • Present the National Planned Care Programme for BPH Task and Finish Group Wales with the results and trial the adoption of the service nationally.


Outcomes

  • A local pathway was developed, involving all stakeholders, which included a business case and a patient referral guide.

  • Patients were allocated dedicated clinic slots; patient information tools, patient reported outcome measures (PROMs) and health resource utilisation (HRU) questionnaires informed decision making.

  • The pathway was implemented; dedicated day case theatre lists with initial, pre-assessment, and follow-up clinic systems were put in place.

  • A total of six patients underwent successful day case implantation of the UROLIFT device.

  • Early follow-up revealed no significant complications, satisfactory clinical improvements and positive patient-reported outcome measures.

  • Direct cost savings of over £350 per patient, including reduced theatre and bed usage, in-keeping with the published results.

  • UroLift has been demonstrated to be safe and clinically effective from both a patient and clinician perspective.

  • The service was evaluated, demonstrating.

  • The project offers a choice of treatments to patients.


Next steps

  • The new service offering minimally invasive treatment has been satisfactorily implemented and can be adopted locally and nationally.

  • The UroLift is now part of the BPH task and finish group recommendation to the planned care board Wales for national adoption.


Anticipated benefits include:

  • Estimated saving of £1.5 million per year in reduced complications for Wales.

  • Estimated direct cost savings of over £25-30K a year in theatre time and bed stay (assuming 30 patients use the service).

  • Improved theatre efficiency, saving 1 theatre hour per case.

  • Improved bed capacity: no overnight stay or delayed transfer, at an estimate of 1200 inpatient bed days per year for Wales.



“Best thing ever, thank you.Patient



Part of cohort Bevan Exemplar Projects 2018-19


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