Advice
The technology
The technology
iTind (Olympus) is a temporary implanted nitinol device. Using local anaesthesia or light sedation, the folded device is inserted into the bladder under direct visualisation using a cystoscope. The device is opened in the bladder. The device is then pulled back and positioned in the prostatic urethra. Over the following days, the pressure applied by struts in the device creates areas of ischaemia in the prostatic urethra and bladder neck. This makes new longitudinal channels through which urine can flow. After 5 to 7 days, lidocaine gel and a flexible silicone Foley catheter are inserted into the urethra. Once the device is folded completely inside the Foley catheter, the Foley catheter is removed from the urethra. Insertion and removal of the device are both done as day case or outpatient procedures.
Innovations
The company says that iTind is a minimally invasive surgical treatment that can be delivered under local anaesthesia or sedation, as a day case or outpatient procedure, taking less than 20 minutes. They also note that it does not involve a permanent implant, heating or removal of prostate tissue and claims that sexual and erectile function is preserved. The company claims that the procedure is routinely catheter free, and people can go home once they have voided, usually a few hours after the procedure. The company also claims that the procedure preserves urinary continence and is suitable for treating people with high bladder necks.
Current care pathway
NICE's guideline on lower urinary tract symptoms in men describes current treatment options. Mild symptoms are usually managed conservatively. Medicines such as alpha blockers and 5 alpha-reductase inhibitors may also be used. If these treatments have not worked, there are several possible surgical options, including transurethral resection of the prostate, transurethral vaporisation, holmium laser enucleation, prostatic urethral lift implant insertion, prostatic artery embolisation and prostatectomy. Potential complications of some of these surgical procedures include bleeding, infection, urethral strictures, incontinence and sexual dysfunction.
Population, setting and intended user
iTind is designed to treat people who have lower urinary tract symptoms caused by benign prostatic hyperplasia.
Insertion and removal of the device are both done as day case or outpatient procedures by urologists. The company says that urologists undergo a training programme free of charge. This training involves a 1‑day didactic course, either in person or online, followed by 4 to 6 iTind cases under supervision of a certified trainer.
Costs
Technology costs
The cost per patient is about £1,208 (excluding VAT).
-
iTind device and removal snare: £1,200
-
22 Fr. single use Foley catheter: £7.50.
Costs of standard care
The cost of standard care depends on the procedure and is provided for consumables only.
-
transurethral resection of the prostate: between £52.60 and £189.34
-
UroLift (4 implants): £1,320
-
Rezum: £1,384.
Experts suggested that bladder neck incision may also be a comparator as well as other laser methodologies such as HoLEP (£97.18) or Greenlight (£550).
Resource consequences
iTind is currently used in 2 NHS trusts.
The company claims that iTind is a rapidly deployable technology. It does not rely on buying capital equipment or ongoing maintenance costs. It can also be done as a day case or in an outpatient setting, avoiding the need for a theatre‑based procedure, general anaesthetics or inpatient stay. The company claims that the ability to treat eligible patients as a day case will reduce pressure on inpatient beds and reduce disruptions from cancelled operations. It also claims it has significant benefits for overall urology services, freeing up operating theatre capacity and improving waiting list management.
The company says that a rigid cystoscope and surgical camera system are needed to insert the iTind device. The company assumes that all centres doing core urology will have these items because they are essential in routine urological practice.