NICE has been notified about this procedure and will consider it as part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
ID number 1569
Description Transurethral water ablation for benign prostatic hyperplasia uses a specialised system that combines image guidance and robotics for the targeted heat-free removal of prostate tissue. The procedure is usually done with the patient under general or spinal anaesthesia. Transrectal ultrasound is used throughout the procedure. A special handpiece with an integrated cystoscope and ablation probe is inserted through the urethra and into the bladder. Positioning is confirmed by using visual markers on a computer screen, and the surgeon is able to plan the depth and angle of resection using the system software. Once the surgical mapping is complete, a high-speed jet of saline is delivered to the prostate at various flow rates, according to the depth of penetration needed. The ablated tissue is aspirated through ports in the handpiece and can be used for histological analysis. Haemostasis can be achieved by cautery or by inflating a Foley balloon catheter inside the prostatic cavity. The average resection time is typically about 3 to 5 minutes. After the procedure, a 3-way Foley catheter is placed under traction and continuous bladder irrigation is started. Traction is removed the evening after the procedure and irrigation is progressively decreased. The catheter is removed before the patient is discharged from hospital, usually the day after the procedure. The possible advantages of the procedure include a reduction in resection time compared with other endoscopic methods, and the potential to preserve sexual function. The procedure is heat-free, which removes the risk of complications arising from thermal injury.

Timeline

Key events during the development of the guidance:

Date Update
24 May 2018 - 21 June 2018 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance