The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on insertion of prostatic urethral lift implants to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, in January 2014.
Benign prostatic hyperplasia (BPH) is a common condition that affects older men. It is characterised by an increase in the size of the prostate, which is caused by an increased number of stromal and epithelial cells. BPH can cause lower urinary tract symptoms including hesitancy during micturition, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention.
Mild symptoms are usually managed conservatively. Drugs such as alpha blockers can be used to relax the smooth muscle of the urethra. Androgen blockers such as 5-alpha-reductase can also be used. If symptoms are more severe, then surgical treatments may be used including transurethral resection of the prostate (TURP) or transurethral vaporisation of the prostate, or holmium laser enucleation of the prostate (see NICE guideline CG97).
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.