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GreenLight XPS for treating benign prostatic hyperplasia (update of MTG29)

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1 Provisional recommendations

1.1 GreenLight XPS is recommended as an option to treat benign prostatic hyperplasia (BPH) in adults.

1.2 More comparative data should continue to be collected on cost saving outcomes when using GreenLight XPS in people that may be considered as high-risk, including those with larger prostates and a higher risk of bleeding.

Why the committee made these recommendations

NICE previously recommended GreenLight XPS for BPH in people in non-high-risk groups. But it asked for more data on people in high-risk groups (previously defined as people with urinary retention, prostates over 100 ml in volume, and a higher risk of bleeding).

Clinical experts advised that urinary retention is now not considered high risk in practice. In the remaining high-risk groups, clinical evidence suggests that GreenLight XPS is as effective as transurethral resection of the prostate (TURP) in treating BPH symptoms. GreenLight XPS is associated with a reduction in hospital stay and less postoperative catheterisation. Sexual function is also more likely to be maintained after the procedure.

The cost modelling suggests GreenLight XPS is likely to be cost saving compared with TURP and holmium laser enucleation of the prostate (HoLEP). By how much depends on day case proportions, length of stay and procedure length.

Although there is enough evidence to recommend GreenLight XPS for people in high-risk groups, comparative data is still needed to be more certain about cost savings.