Transurethral steam ablation for lower urinary tract symptoms in men

This is a new guideline from NICE recommending that transurethral water vapour ablation can be used for treating lower urinary tract symptoms (LUTS) in men. It was published in Aug 18. This procedure is also know as transurethral steam ablation.

You'll probably have heard about this in the news, but I thought it worth blogging about it so you can see if it's worth all the hype.

I've also added a paragraph on water jet ablation at the end. This is considered safe, but there isn't enough evidence on its efficacy to advise regular use.

This is normally done as a day case. It can be done using regional block or sedation. Under direct visualisation, water vapour is delivered to the prostate. The heat causes rapid cell death. Saline irrigation is used to cool and protect the urethra. The size of the prostate is normally reduced leading to an improvement in symptoms within 1-3 months.

Are there downsides? Some patients will have to take antibiotics and some will need a catheter for a few days post-op. Sex has to be avoided for a month after surgery. There are adverse effects associated. The studies have been small, so these figures may not be very accurate. The following are just some of them. Incontinence (long term) may affect up to 4% of men.  Frequency and urgency may affect around 7% of men post-op. Erectile dysfunction affected around 3% of men.

What are the upsides? The NICE committee were in a bit of disagreement over this. Some felt that this was just another tool in the toolbox, whereas some felt it was a really novel treatment because of the use of steam. It has not been compared head to head with other treatments, so it is hard to be sure how side-effects compare, but it does seem to have less effect on sexual function than other treatments.

The following Medtech Innovation Briefing gives more information about the background to the treatment than the link to the actual guideline does.

NICE has also just released guidance on water jet ablation for BPH. Here a water jet is aimed at the prostate under ultrasound guidance. The procedure is quick and may also have a reduced impact on sexual functioning. Patients will need an overnight stay. There is good evidence on it's safety, but not on it's efficacy, so it's not being advised for routine use yet.

I’m a freelance GP locum in Winchester & Southampton.

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