Prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia

Evidence-based recommendations on prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia. This involves positioning a temporary implant in the urethra to increase the flow of urine.

# Recommendations
Evidence on the safety and efficacy of prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia should:
Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
Patient selection should be done by a team experienced in managing benign prostatic hyperplasia. The procedure should only be done by clinicians with specific training in the technique.
Further research could include registry data or randomised controlled trials using a suitable comparator. It should report details of patient selection, including size of prostate, and longer-term outcomes, including the need for reintervention.# The condition, current treatments and procedure

# The condition
Lower urinary tract symptoms caused by benign prostatic hyperplasia commonly affect men aged over 50. Benign prostatic hyperplasia results from an increased number of stromal and epithelial cells. These cells are typically 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.

# Current treatments
NICE's guideline on lower urinary tract symptoms in men describes current treatment options. Mild symptoms are usually managed conservatively. Medicines such as alpha blockers and 5alphareductase inhibitors may also be used. If other treatments have not worked, there are several possible surgical options, including transurethral resection of the prostate, transurethral vaporisation, holmium laser enucleation, prostatic urethral lift implant insertion, prostatic artery embolisation and prostatectomy. Potential complications of some of these surgical procedures include bleeding, infection, urethral strictures, incontinence and sexual dysfunction.

# The procedure
The aim of prostatic urethral temporary implant insertion is to relieve symptoms of benign prostatic hyperplasia by creating new channels in the urethra to increase the flow of urine. The aim of using a temporary implant is to avoid complications from an implant left in place long term.
Local anaesthesia or light sedation is used. A folded device made from nitinol is deployed into the bladder under direct visualisation using a cystoscope. The device is opened in the bladder and retracted into the prostatic 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 of the device is usually done as a day-case procedure and removal is done as a day-case or outpatient procedure.