HNY Policy and Pathway Repository - East Riding

Proven bladder outflow obstruction related to prostate enlargement

Interventions include but are not limited to: Transurethral resection of prostate (TURP), Transurethral incision of the prostate (TUIP), Bladder Neck Incision (BNI), Holmium LASER enucleation of the prostate, 532 nm laser vaporisation of the prostate (e.g. ‘GreenLight’), UroLift, Transurethral vaporisation of the prostate (TUVP), Transurethral water vapour therapy (Rezum), Aquablation and Simple robotic prostatectomy.

 

These interventions are commissioned if the following criteria are met:

• Patients have severe voiding symptoms AND a diagnosis of BOO meeting European Association of Urology criteria i.e.:
  • the patient cannot void >150mls OR
  • the maximum flow is <10mls/s OR
  • a post void residual >300mls, in men between the ages of 50 and 80.

AND

• Drug treatment and conservative interventions (such as bladder training, hydration management and pelvic floor exercises) have been unsuccessful or are not appropriate.

 

Use of a surgical intervention should be considered using a shared decision-making approach with patients.

NICE recommends that patients with lower urinary tract voiding symptoms, presumed secondary to Benign Prostatic Obstruction, should be offered surgical intervention as part of a stepped approach to management.

 

TURP has long been the mainstay of surgical treatment for voiding LUTS presumed secondary to prostatic enlargement but there is also an emerging suite of minimally invasive surgical treatments (MISTs) which are replacing TURP as the mainstay of treatment. The increased range of treatments has meant that there is now a requirement for specialist assessment to include more complex discussions with patients about their options. A decision aid to support patients through the selection of individualised treatment options is recommended.

 

Open simple/benign prostatectomy is very rare and is only undertaken in men with very large prostates and problematic symptoms.

Surgical intervention for Bladder Outflow Obstruction (BOO) - EBI

CG97 Lower urinary tract symptoms in men: management NICE