2 The condition, current treatments and procedure
2.1 Lower urinary tract symptoms caused by benign prostatic hyperplasia commonly affect men over 50. Stromal and epithelial cells increase in number, causing the prostate to increase in size. It often occurs in the periurethral region of the prostate, with large discrete nodules compressing the urethra. Symptoms include hesitancy during micturition, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention.
2.2 Mild symptoms are usually managed conservatively. Drugs may also be used, such as alpha blockers and 5-alpha-reductase inhibitors. If other treatments have not worked, there are a range of surgical options that may be considered including transurethral resection of the prostate, transurethral vaporisation, holmium laser enucleation, insertion of prostatic urethral lift implants, prostatic artery embolisation or prostatectomy (see the NICE guideline on lower urinary tract symptoms in men). Potential complications of some of these surgical procedures include bleeding, infection, urethral strictures, incontinence and sexual dysfunction.
2.3 Prostatic urethral temporary implant insertion aims to relieve symptoms of benign prostatic hyperplasia by creating new channels in the urethra that increase the flow of urine, without having the complications of an implant left in situ.
2.4 Using local anaesthesia or light sedation, a folded device made from nitinol is inserted into the prostatic urethra with a cystoscope under direct visualisation. The device opens in the urethra. Over the following days, the pressure applied by struts in the device creates areas of ischaemia in the prostatic urethra and bladder neck. This makes new longitudinal channels through which urine can flow. After 5 to 7 days lidocaine gel and a flexible silicone extraction catheter are inserted into the urethra and the device is removed. Insertion and removal of the device are both done as a day case procedure and take about 5 minutes.