Transurethral water vapour ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia

Evidence-based recommendations on transurethral water vapour ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia in adults. This involves using heated water vapour to destroy some of the prostate tissue.

# Recommendations
Current evidence on the safety and efficacy of transurethral water vapour ablation for urinary tract symptoms caused by benign prostatic hyperplasia is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
This procedure should only be done by a urologist with specific training in the procedure, who should carry out their initial procedures with an experienced mentor.# The condition, current treatments and procedure

# The condition
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 peri-urethral 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
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 (TURP), transurethral vaporisation, holmium laser enucleation, insertion of prostatic urethral lift implants, prostatic artery embolisation or prostatectomy (see the NICE clinical 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.

# The procedure
Transurethral water vapour ablation is usually done as day-case surgery using local anaesthetic including a peri-prostatic block, and sometimes sedation. A device similar to a rigid cystoscope is advanced into the prostatic urethra. Under direct visualisation, a retractable needle is inserted into the prostate and water vapour (at a temperature of about 103 degrees centigrade) is delivered for 8 to 10 seconds. At the same time, saline irrigation is used to cool and protect the surface of the urethra. Conductive heat transfer disrupts cell membranes in the prostate, leading to rapid cell death. The needle is retracted and repositioned several times so that thermoablation can be repeated in different areas of the gland, including the median lobe. The aim is to reduce the size of the prostate, leading to improvement in lower urinary tract symptoms 1 to 3 months after treatment, without impairing sexual function.
Patients may have to take antibiotics and have a urinary catheter for some days after the procedure. Some activities, including sexual intercourse, should be avoided for up to 1 month.