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UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia

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2 The technology

Technology

2.1 The UroLift System (NeoTract) is used to do a prostatic urethral lift, a procedure that relieves lower urinary tract symptoms. It uses adjustable, permanent implants to pull excess prostatic tissue away from the urethra so that it does not narrow or block the urethra. The system comprises 2 single-use components: a delivery device and an implant. The delivery device consists of a hand-held pistol grip with a needle-shaped probe attached. Each UroLift implant consists of a superelastic nitinol capsular tab (a piece of metal holding 1 side of the suture), a polyethylene terephthalate monofilament suture, and a stainless steel urethral end-piece. The surgeon inserts the probe into the urethra until it reaches the prostatic urethra (the widest part of the urethral canal). A fine needle at the end of the probe deploys and secures an implant in a lobe of the prostate. One end of the implant is anchored to the firm outer surface of the prostatic capsule, while the other is on the inside of the urethra. When the device is tightened, the prostatic tissue is pulled away from the urethra. This is repeated on the other lobe of the prostate. Typically, about 4 implants are used to ensure that the urethra is widened. The procedure can be done under local or general anaesthetic on an inpatient or day‑case basis.

Innovative aspects

2.2 Treatment with UroLift does not involve cutting or removing tissue. The implants are permanent but adjustable, so the procedure is reversible, and people can have other surgical treatments later if needed. UroLift is less invasive than standard treatments and may reduce the need for post-operative catheterisation and catheterisation time. UroLift is a quick procedure that can be done as a day case, so it may reduce the need to stay in hospital.

Intended use

2.3 UroLift is intended for treating symptoms caused by urinary outflow obstruction secondary to benign prostatic hyperplasia, affecting the lateral and median lobes, in people of 50 years and older. This indication was updated in 2020. UroLift should not be used if prostate volume is more than 100 ml, or if people have urinary tract infections, urethral conditions that prevent the delivery system being inserted into the bladder, urinary incontinence caused by an incompetent sphincter, or current gross haematuria. The company states that UroLift treatment can be done under local anaesthetic, without an anaesthetist present, with light sedation if needed.

Relevant pathway

2.4 The relevant NICE Pathway described in the decision problem for this technology is the NICE Pathway for managing lower urinary tract symptoms in men.

Costs

2.5 The cost of the UroLift System (comprising 1 delivery device and 1 implant) stated in the company's submission is £400 (excluding VAT). An average of 4 implants is used per procedure and so the typical cost per person is £1,600.