2 The technology

Technology

2.1 The UroLift System (Teleflex Inc.) is used to do a prostatic urethral lift, a procedure that relieves lower urinary tract symptoms. It uses implants to pull excess prostatic tissue away from the urethra so that it does not narrow or block the urethra. The system comprises 2 single-use components: a delivery device and an implant. The delivery device consists of a hand-held pistol grip with a needle-shaped probe attached. Each UroLift implant consists of a superelastic nitinol capsular tab (a piece of metal holding 1 side of the suture), a polyethylene terephthalate monofilament suture, and a stainless-steel urethral end-piece. The surgeon inserts the probe into the urethra until it reaches the prostatic urethra (the widest part of the urethral canal). A fine needle at the end of the probe deploys and secures an implant in a lobe of the prostate. One end of the implant is anchored to the firm outer surface of the prostatic capsule, while the other is on the inside of the urethra. When the device is tightened, the prostatic tissue is pulled away from the urethra. This is repeated on the other lobe of the prostate. Typically, about 4 implants are used to widen the urethra. The procedure is done under local or general anaesthesia and usually as a day‑case or outpatient procedure. Sometimes UroLift is done as an inpatient treatment depending on the person's circumstances. For example, if they have comorbidities or no home support.

Innovative aspects

2.2 Treatment with UroLift does not involve cutting or removing tissue. The implants can be partially removed, so the procedure is reversible, and people can have other surgical treatments later if needed. UroLift is less invasive than standard treatments and may reduce the need for postoperative catheterisation and catheterisation time. UroLift is a quick procedure that can be done as a day-case or outpatient procedure, so it may reduce the need to stay in hospital.

Intended use

2.3 UroLift is intended for treating symptoms caused by urinary outflow obstruction secondary to benign prostatic hyperplasia affecting the lateral and median lobes, in people aged 50 and older. This indication was updated in 2020. According to the UK instructions for use, UroLift should not be used if prostate volume is more than 100 ml or if people have a urinary tract infection. Clinical experts also advised that people need to be assessed on an individual basis to check if the procedure is suitable for them. This is because some clinicians may consider that other conditions, such as chronic urinary retention, are contraindications. The company states that UroLift treatment can be done under local anaesthetic, with light sedation if needed.

Relevant pathway

2.4 The NICE Pathway for managing lower urinary tract symptoms in men is relevant and is described in the decision problem for UroLift.

Costs

2.5 The cost of the UroLift System (comprising 1 delivery device and 1 implant) stated in the company's submission is £400 (excluding VAT).

  • National Institute for Health and Care Excellence (NICE)