Published today, the medical technology guidance from the National Institute for Health and Care Excellence encourages the NHS to use the TransUrethral Resection in saline (TURis) system (Olympus Medical). This device, which is similar to an endoscope with a diathermy wire in front of the camera, uses a bipolar electrosurgery system to cut away or vaporise excess prostate tissue.
Using the TURis system reduces the need for blood transfusion. The length of hospital stay and rates of hospital readmission may also be reduced. The device also avoids the risk of TUR syndrome – a rare but serious complication of prostate resection, which can occur with monopolar electrosurgery. The guidance estimates that hospitals could save up to £375 per patient by using this bipolar system, compared with monopolar transurethral resection of the prostate (TURP).
Prostate enlargement is a common condition in older men – around 60% of men aged 60 or over have some degree of prostate enlargement. The enlarged prostate gland may press on the urethra and so can make passing urine more difficult. The condition doesn’t pose other direct risks to health, but complications of a blocked urine tract include severe urinary tract infections, urinary retention or renal failure. Surgery is offered when problems passing urine are severe, or if drug treatment and conservative management options have been unsuccessful or are not appropriate. Approximately 15,000 prostate resection procedures are carried out each year in England and Wales.
In electrosurgery, the tool that the surgeon uses to cut tissue has an electric current running through it which seals the cut and so reduces bleeding. To complete the electrical circuit, a return electrode is needed. The TURis system’s bipolar design has an internal return electrode within the device which means that a return electrode does not need to be stuck onto the patient’s skin. Also, unlike monopolar electrosurgery, the bipolar TURis system doesn’t use glycine solution to flush out blood and debris from the urethra, which therefore avoids any risk of a problem called TUR syndrome.
Professor Carole Longson, Director of the NICE Centre for Health Technology Evaluation, said: “We’re pleased to publish this new guidance which will help the thousands of men each year who need surgery because of problems caused by an enlarged prostate gland.
“The NICE guidance recommends that the TURis system should be considered for use in patients where surgery is needed because of severe symptoms associated with an enlarged prostate, such as a blocked urinary tract. The TURis system offers a range of benefits for patients – this bipolar electrosurgery system avoids the risk of a potentially fatal syndrome which can occur with the more commonly performed monopolar prostate electrosurgery. It may also mean a shorter hospital stay and less chance of needing to be readmitted to hospital after treatment.
“Having examined the evidence, the independent Medical Technologies Advisory Committee has concluded that as well as benefiting patients by reducing the need for blood transfusion, using the TURis system is also likely to benefit the NHS by potentially saving up to £375 per patient.”
The NICE medical technology guidance on the TURis system is available at http://www.nice.org.uk/guidance/mtg23.
For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142, or out of hours on 07775 583 813.
Notes to Editors
About the NICE guidance
1. The medical technologies guidance, “The TURis system for transurethral resection of the prostate”, is available at http://www.nice.org.uk/guidance/mtg23 from Wednesday 25 February.
2. The TURis system (TransUrethral Resection in saline) is manufactured by Olympus Medical.
3. Using the transurethral resection in saline (TURis) system instead of monopolar transurethral resection of the prostate (TURP) results in an estimated saving of £71 per patient for hospitals that already use an Olympus monopolar system and an estimated additional cost of £20 per patient for other hospitals. However, there is some evidence of a reduction in readmissions with the TURis system compared with monopolar TURP. If this evidence is included, using the TURis system results in an estimated saving of £375 per patient for hospitals that already use an Olympus monopolar system and an estimated saving of £285 per patient for other hospitals.
4. The list prices for the components of the TURis system for transurethral resection of the prostate (excluding VAT) are:
• £8905 for the resectoscope assembly (which includes the active working element, telescope, inner and outer sheath, light guide cable and saline cable)
• £14,681 for an ESG-400 Olympus generator
• Single-use roller and loop electrodes are £156.67 and £126.67 respectively. Each TURis procedure uses 1 loop electrode and some procedures, typically 1 in 5, use an additional roller electrode.
The ESG 400 Olympus generator is usually provided at no cost as part of contractual arrangements with Olympus to purchase electrodes at list price.
5. The Committee noted there was clinical evidence showing that use of the TURis system avoids the risk of TUR syndrome and reduces patients’ need for blood transfusion compared with monopolar transurethral resection of the prostate (TURP). TUR syndrome is a rare but potentially fatal complication of TURP surgery when monopolar electrosurgery is used, occurring in around 1 in 100 procedures. During monopolar TURP, glycine is used to clear the urethra of blood and debris. When glycine is absorbed into the bloodstream, it can cause a potentially dangerous build-up of fluid in the circulation, leading to fluid overload and hyponatraemia (low sodium level in the blood). The TURis system does not use glycine which removes the risk of this complication.
About the Medical Technologies Evaluation Programme
6. The Medical Technologies Evaluation Programme focuses specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions. The independent Medical Technology Advisory Committee has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. The guidance applies to the NHS in England, and is not mandatory. More information is available at http://www.nice.org.uk/MT.
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