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.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.