The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on transurethral electrovaporisation of the prostate in October 2003.
Further recommendations have been made as part of the clinical guideline on lower urinary tract symptoms published in May 2010, as follows:
If offering surgery for managing voiding lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic enlargement (BPE), offer monopolar or bipolar transurethral resection of the prostate (TURP), monopolar transurethral vaporisation of the prostate (TUVP) or holmium laser enucleation of the prostate (HoLEP).
Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from NICE guideline CG97. The interventional procedure guidance on transurethral electrovaporisation of the prostate remains current, and should be read in conjunction with the clinical guideline.
This procedure is used to treat benign prostatic obstruction (BPO.) BPO is a non-malignant enlargement of the prostate and is a common cause of lower urinary tract symptoms in men older than 40 years of age.
BPO can be managed either medically or surgically. The standard surgical treatment is transurethral resection of the prostate. However, relatively high morbidity for this procedure has led to the development of a range of minimally invasive techniques, some of which utilise thermal energy. Transurethral electrovaporisation of the prostate is one such technique which utilises high voltage electrical current to vaporise prostatic tissue and create a cavity in the prostate, so that symptoms caused by obstruction are reduced.
Transurethral electrovaporisation of the prostate, an electroablative technique, is performed with a specially designed modified rollerball electrode. Under general or spinal anaesthesia, electrical energy is applied for cutting and for coagulation. The electrode is rolled over the prostatic tissue to create an area of vaporisation of 3 to 4 mm and an underlying coagulative necrosis of 0.1 to 0.5mm. Vaporisation continues until an appropriate cavity is created.