A minimally invasive treatment for enlarged prostate

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.

Part of cohort Bevan Exemplar Projects 2018-19