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The prostate surgery alternatives helping men reclaim their lives

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Benign prostate enlargement or BPE is a common condition typically affecting men over 50. Up to three million men in the UK have urinary tract symptoms associated with BPE which can severely impact on their quality of life.

Transurethral resection of the prostate (TURP) has historically been the go-to treatment for BPE. However, many men are reluctant to undergo the invasive surgery.

Two BPE treatments developed by Boston Scientific have fast-tracked for funding under the NHS MedTech Funding Mandate PolicyGreenLight XPS System and Rezūm System. These less invasive treatments can be performed in just 30 minutes.

Health Tech World sat down with Hampshire Hospitals consultant urologist Mr Richard Hindley to find out more about how these new treatment options are helping men across the country.

What impact does BPE have on a man’s day-to-day life?

BPE is a common condition that has been historically associated with men in their 80s.

But the world has changed now. We’re well aware that this can manifest in men in their late 40s and early 50s.

Richard Hindley

Many of these men will suffer from urinary symptoms. That’s because the prostate gland is growing, and a very significant minority of those men will end up on medication or having interventional surgery.

I’ve been involved with the introduction of a number of technologies to my hospital in the last 15-16 years, including most recently the Rezūm treatment, which is now being adopted around the UK.

It’s been a busy period but very enjoyable. I’m pleased that men now have an expanding portfolio of treatment options rather than just two extremes of medication or TURP.

What are some of the problems associated with the TURP procedure?

Five to 10 per cent of men will have a deterioration in their erectile function after the procedure. And the vast majority will find that their ejaculation dries up.

There are small but significant risks of incontinence, a blood transfusion and a hospital stay of two or three days. For those reasons, men have to take medication or will just tolerate their symptoms until things become really bad.

Boston Scientific have developed two innovations that make treating BPE a much less daunting prospect. How do they work?

Greenlight is like a safe TURP in that it creates a nice passageway through the prostate, but it in a very clever way with a reduced risk of bleeding and a quicker recovery.

Rezūm is more for men who are earlier on in their journey of troublesome symptoms.

They may decide that they would rather have a minimally invasive intervention than go on medication, or they’ve tried medication and their symptoms have progressed from being mild to moderately bothersome.

Many men are demanding to be considered for one of these newer minimally invasive, less harmful interventions because they have concerns about having a bigger operation.

Why are these being funded under the MedTech accelerator?

For a combination of reasons. Both have been through the NICE evaluation process and have been deemed to be cost effective.

There is also something of a postcode lottery when it comes to the options available in a particular region. Not all men are offered the range of options or even the chance to go to a nearby hospital to have that treatment option.

Rezūm Water Vapour Therapy System

There is also a rapidly expanding waiting list post-pandemic. And at the top of the list of long urology waiting list are men waiting for bladder outlet obstruction surgery, which is essentially prostate surgery.

Many of those men are waiting for a TURP which requires an inpatient bed for at least a couple nights.

Encouraging a diversion of the traffic towards a day unit with same-day discharge will allow those patients to receive their treatments in a more timely manner.

Why might a urologist be reluctant to recommend one of these new procedures?

Many urologists are very keen on the TURP procedure. It’s been around a long time and it is a reasonably durable procedure. And with the minimally invasive treatments, men might be more likely to come back in their lifetime for another procedure.

But the reality is that men are very happy with that arrangement. And far too many men are waiting for over a year for a prostate operation with a with a tube coming out through their penis, which has a huge impact on quality of life.

This is really unacceptable. So it may be that we need to trade off durability of these procedures for the possibility that a man may not have to wait as long for his treatment, and may also be less likely to suffer from sexual function and urinary control issues.

What kind of feedback have you had from patients who’ve received one of these systems?

GreenLight XPS Laser Therapy System

We’ve had very good feedback over many years. We’ve recently published our experience of the first 461 men that we’ve treated.

We asked them to complete a satisfaction questionnaire at six months after the procedure, and 90 per cent were somewhat satisfied or very satisfied and would recommend the procedure to friends or family or would go through it again.

The problem is, as clinicians, we get focused on the objective measures. But really, it’s about the patient’s feedback. It’s about their perceptions. That’s what’s important.

We’re doing some work at the University of Winchester psychology department digging deep on men’s decisions around why they select one treatment over another.

We’re hoping to develop an aid for clinicians that highlights a patient’s hopes and concerns, perhaps a ranking of issues like fear of sexual problems, fear of incontinence, or whatever they may be.

We’re also hoping identify some key questions to ask patients that would open up that discussion and help get to the bottom of patients’  wishes and concerns.

If we can do that, we’re even better at selecting the right treatment because no two people are the same.

We’ve all got different-sized prostates, different anatomy, different problems, different emotional baggage. It’s about trying to unravel all of that.

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