PLASMA system with button electrode for electrovaporisation of the prostate

The technology described in this briefing is PLASMA with an oval button electrode. It is used for bipolar transurethral vaporisation resection of the prostate (TUVP).

The innovative aspects are that the button electrode vaporises prostate tissue rather than resects tissue, and it is intended to remove tissue at a faster rate. Vaporisation minimises bleeding and allows the endoscopic view to remain clear throughout the procedure.

The intended place in therapy would be as an alternative to transurethral resection of the prostate (TURP) in people with benign prostatic hyperplasia that needs surgical intervention.

The main points from the evidence summarised in this briefing are from 4 studies: 1 meta-analysis (consisting of 9 randomised controlled trials, 1 prospective non-randomised study and 1 retrospective study), 1 randomised prospective study and 2 retrospective studies, including a total of 2,171 patients with benign prostatic hyperplasia. They show that the PLASMA system with button electrode is as effective as TURP for people with benign prostatic hyperplasia and as effective as open prostatectomy for people with prostates larger than 80 g.

Key uncertainties around the evidence are that there have been no studies done within an NHS context, so populations may not be applicable to NHS practice. Button electrode vaporisation has been used for small and large prostate sizes too, so transurethral incision and open prostatectomy may also be considered as comparators.

Safety issues identified are blood in the urine, cramping in the bladder, frequent urination and a burning sensation.

The cost of the TUVP procedure using the PLASMA button electrode is approximately £988 per procedure (excluding VAT). The cost of standard care is £972 per procedure (excluding VAT). The difference in cost is because of the difference in electrode cost.