NICE guidance supports use of TransUrethral Resection in saline system for men needing surgery on enlarged prostate glands
TURis has been found to improve outcomes for men being treated for prostate conditions
A novel surgical system for reducing the size of enlarged prostate glands in men is supported by new NICE guidance.
Published last week, the medical technology guidance from the National Institute for Health and Care Excellence encourages the NHS to use the TransUrethral Resection in saline (TURis) system from Olympus Medical. 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.
We’re pleased to publish this new guidance which will help the thousands of men each year who need surgery because of problems caused by an enlarged prostate gland
Using the TURis system reduces the need for blood transfusion and the length of hospital stay and rates of hospital readmission may be reduced, the guidance states. The device also avoids the risk of TUR syndrome – a rare-but-serious complication of prostate resection, which can occur with monopolar electrosurgery. The guidance estimates that hospitals could save up to £375 per patient by using this bipolar system, compared with monopolar transurethral resection of the prostate (TURP).
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.
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 solution to flush out blood and debris from the urethra, which therefore avoids any risk of a problem called TUR syndrome.
Professor Carole Longson, director of the NICE Centre for Health Technology Evaluation, said: “We’re pleased to publish this new guidance which will help the thousands of men each year who need surgery because of problems caused by an enlarged prostate gland.
This bipolar electrosurgery system avoids the risk of a potentially-fatal syndrome which can occur with the more commonly-performed monopolar prostate electrosurgery. It may also mean a shorter hospital stay and less chance of needing to be readmitted to hospital after treatment
“The NICE guidance recommends that the TURis system should be considered for use in patients where surgery is needed because of severe symptoms associated with an enlarged prostate, such as a blocked urinary tract. The TURis system offers a range of benefits for patients – this bipolar electrosurgery system avoids the risk of a potentially-fatal syndrome which can occur with the more commonly-performed monopolar prostate electrosurgery. It may also mean a shorter hospital stay and less chance of needing to be readmitted to hospital after treatment.
“Having examined the evidence, the independent Medical Technologies Advisory Committee has concluded that as well as benefiting patients by reducing the need for blood transfusion, using the TURis system is also likely to benefit the NHS by potentially saving up to £375 per patient.”