The National Institute for Clinical Excellence is examining transurethral electrovaporisation of the prostate and will publish guidance on its safety and efficacy to the NHS in England and Wales. The Institute's Interventional Procedures Advisory Committee has considered the available evidence and the views of Specialist Advisors, who are consultants with knowledge of the procedure. The Advisory Committee has made a provisional recommendation about transurethral electrovaporisation of the prostate.

This document has been prepared for public consultation. It summarises the procedure and sets out the provisional recommendation made by the Advisory Committee.

Note that this document is not the Institute's formal guidance on this procedure. The recommendation is provisional and may change after consultation. The process that the Institute will follow after the consultation period ends is as follows.

• The Advisory Committee will meet again to consider the original evidence and its provisional recommendations in the light of the comments received during consultation.
• The Advisory Committee will then prepare the Final Interventional Procedures Document (FIPD) and submit it to the Institute.
• The FIPD may be used as the basis for the Institute's guidance on the use of the procedure in the NHS in England and Wales.

For further details, see the Interim Guide to the Interventional Procedures Programme, which is available from the Institute's website (www.nice.org.uk/ip).

Closing date for comments: 24 June 2003

Target date for publication of guidance: 24 September 2003

Note that this document is not the Institute's guidance on this procedure. The recommendation is provisional and may change after consultation.

Current evidence on the safety and efficacy of transurethral electrovaporisation of the prostate (TEVAP) appears adequate to support the use of the procedure, provided that normal arrangements are in place for consent, audit and clinical governance

Indications

Transurethral electrovaporisation of the prostate (TEVAP) is used to treat benign prostatic hyperplasia (BPH), a non-malignant enlargement of the prostate that is a common cause of lower urinary tract symptoms and bladder outlet obstruction in men over 40. TEVAP is a minimally invasive alternative to the standard surgical treatment of BPH, transurethral resection of the prostate (TURP).

TEVAP, an electroablative technique, is performed using a specially designed modified rollerball electrode. The electrode is rolled over the prostatic tissue to create an area of vaporisation and an underlying coagulative necrosis. Vaporisation continues until an appropriate cavity is created. An in-dwelling urethral catheter is left in place at the end of the procedure.

TEVAP is a relatively well-established minimally invasive treatment for BPH. There were a number of randomised controlled trials of this procedure available. TEVAP was shown to be as efficacious as TURP in the short term.

The Specialist Advisors noted that the long-term durability of the procedure has yet to be established, and that efficacy is probably limited to smaller prostates.

Complication rates of TEVAP and TURP appeared to be similar, although some studies suggested that bleeding was less common with TEVAP. One study reported that long-term irritative symptoms were more common with TEVAP.

The Specialist Advisors did not report any particular safety concerns, although one Advisor stated that post-operative bleeding and metabolic disorders were potential complications.