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UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia

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1 Recommendations

1.1 Evidence supports the case for adopting the UroLift System for treating lower urinary tract symptoms of benign prostatic hyperplasia in the NHS. The UroLift System relieves lower urinary tract symptoms, avoids risk to sexual function, and improves quality of life.

1.2 The UroLift System is a minimally invasive procedure. It should be considered as an alternative to transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) as a day-case procedure for people who are 50 years and older with a prostate volume of less than 100 ml.

1.3 Cost modelling shows that the UroLift System is likely to be cost saving compared with standard treatments. Over 5 years, if done as a day-case procedure, UroLift is estimated to save, per person:

  • £981 compared with bipolar TURP

  • £1,242 compared with monopolar TURP

  • £1,230 compared with HoLEP.

Cost savings are because of reduced length of stay and procedure time. Savings compared with transurethral water vapour therapy using Rezum are unclear because of uncertain assumptions in the cost modelling for that comparison. There is uncertainty about whether UroLift is cost saving when treating benign prostatic hyperplasia with an obstructive median lobe because of the need for more UroLift implants.

Why the committee made these recommendations

The UroLift System inserts adjustable, permanent implants using a minimally invasive procedure. The implants hold excess prostate tissue away from the urethra so that it is not blocked. The aim is to relieve lower urinary tract symptoms such as difficulty urinating.

New clinical evidence available since the original guidance was published in 2015 shows that UroLift relieves lower urinary tract symptoms for up to 5 years. It also shows that UroLift improves quality of life and is unlikely to affect sexual function.

Cost analyses suggest that when UroLift is used instead of TURP or HoLEP, it is likely to lead to cost savings. This is because it is done as day surgery with reduced operating and recovery costs. Compared with Rezum, cost savings for UroLift are uncertain and depend on whether flexible cystoscopy is used before the procedure and the number of implants needed for UroLift. More implants are needed when UroLift is used for obstructive median lobe treatment, which means that additional cost may be incurred when compared with Rezum.