A new device to help cut away excess prostate tissues has been given NICE technology guidance support.
The device is for the use of the TransUrethral Resection in saline (TURis) system. This is similar to an endoscope with a diathermy wire in front of the camera, and uses a bipolar electrosurgery system to vaporise prostate tissue.
Using the TURis system reduces the need for blood transfusion, and the length of hospital stay and rates of hospital readmission may also be reduced. The device also eliminates TUR syndrome – a rare but serious complication of prostate resection, which can occur with monopolar electrosurgery. The draft guidance estimates that savings of up £375 per patient could be made using this system.
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 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: “The problems caused by an enlarged prostate gland affect many men as they get older. The supportive provisional recommendation for the TURis system advises that it should be considered for use in patients where surgery is needed because of severe symptoms associated with an enlarged prostate. The evidence examined by the independent Medical Technologies Advisory Committee indicates that as well as benefiting patients by reducing the need for blood transfusion, it’s also likely to benefit the NHS by saving money. We welcome comments on the draft guidance as part of the current consultation.”