25 June 2019

Spreading new approaches to prostate surgery

Enlarged prostate is a common condition but traditional surgical methods can cause some serious side-effects. A new technique called UroLift®, being spread across the region with support from UCLPartners, is revolutionising the way enlarged prostate is treated and the patient experience.

For men over 50, the prostate gland can become troublesome. This gland, which sits in the pelvis, is usually small, but in 40 per cent of men over 50, and 75 per cent of men in their seventies, it becomes enlarged, putting pressure on the bladder, causing difficulty with urination. The gold standard treatment – transurethral resection of the prostate (TURP) – is not complicated, but it requires a two-day hospital stay, with all the attendant costs and health risks. It can also result in some outcomes that have a major impact on quality of life, including erectile dysfunction and difficulty ejaculating.

Image courtesy of Barts Health NHS Trust

‘We were aware of the need to offer day-case prostate surgery,’ says Paul Erotocritou, Consultant Urological Surgeon at Whittington Health NHS Trust, ‘so we started looking around. We investigated laser, but the initial outlay made it impossible for us. When we first heard of UroLift, we were sceptical, but when we looked at it, we were impressed. It’s less invasive for the patient than TURP and cost-wise it’s effective too, because the only outlay is the consumable products themselves – implants (staples).’

There is reduced risk of bleeding, reduced recovery time and no need for admission to the ward for post-operative recovery

The UroLift System treatment is a straightforward procedure that is performed by a Urologist. The Urologist places tiny implants to hold the prostate lobes apart, like open curtains on a window, to relieve compression on the urethra. This allows urine to flow normally again. Patients return home the same day, typically without a catheter.

The procedure itself is significantly less invasive than TURP. Paul explains: ‘With TURP, you are cutting the prostate tissue from the inside, where it is bulging into the water pipe, to get a nice channel to pass urine through. But with UroLift, you’re not cutting any tissue, so there is reduced risk of bleeding, reduced recovery time and no need for admission to the ward for post-operative recovery.’ It is also done under sedation or local anaesthetic, rather than general or spinal anaesthetic.

An important organisational benefit is the reduced demand on theatre time and hospital beds: ‘UroLift takes 20 minutes, compared to 60 minutes for TURP,’ says Paul. Last week, in a half day, I managed to do six UroLift cases for my patients. If that was for TURP, I would only have been able to do three. That means in the operating time available to me I was able to treat twice the number of patients and save 12 nights’ hospital stay – a big impact on a hospital.’

In the operating time available to me I was able to treat twice the number of patients and save 12 nights’ hospital stay – a big impact on a hospital

Paul still recommends TURP for some patients, depending on the position and size of the enlargement, but he finds that UroLift is effective for most patients and is particularly effective when the prostate is bulging from the side and in younger patients put off by surgery due to sexual side effects. ‘Just from looking, I can usually see the outcome I can give a patient with a TURP, and what a UroLift will give them,’ he says.

Overall, Paul is happy: ‘It’s still relatively early in our adoption of UroLift, and we are still following patients up, but actually I would say a good 80 per cent of them have had very good effects,’ he says, ‘and I’ve never had anyone stay overnight after the procedure. It does make a difference.’

Project timeline

UroLift is a product included on NHS England’s Innovation and Technology Payment programme (ITP). ITP products are supplied at zero cost to providers.

UCLPartners works closely with NHS England and local NHS partners to roll out ITP products, sharing information about the products themselves and the training available, and then cascading the information to innovation leads within trusts.

UroLift is now supported by six of our partner trusts as a proven innovation that can make a positive difference to healthcare. Two further trusts are undertaking pilots using the product.

UroLift has now been selected as a product for ‘Rapid Uptake’ through the Accelerated Access Collaborative, which brings industry, government and the NHS together to remove barriers to uptake of innovations, so that NHS patients have faster access to innovations that can transform care.