June 13th 2019 A day case treatment requiring only a few hours in hospital and no cutting, heating or removal of tissue is now available at Tallaght University Hospital (TUH) following a successful pilot. The minimally invasive technology treats Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate gland a condition which affects one in four men over the age of 40.
The new treatment called UroLift replaces a traditional operation to remove prostate tissue by methods including cutting, heating or vapourising, which can involve an average two to three night stay in hospital. The most commonly performed traditional operation is called Transurethral Resection of the Prostate (TURP). Prior to UroLift, approximately 100 TURPs are performed each year in TUH, a National Centre for Urology[[1]]. In TUH, this equated to approximately 200-300 bed-days per year.
It is estimated about 50% of patients requiring a traditional operation could be suitable for UroLift, saving a considerable number of bed-days and is less invasive for patients.
The UroLift System treats symptoms due to urinary outflow obstruction secondary to BPH in men. These symptoms include: difficulty starting a urine stream; weak or interrupted stream; a frequent need to urinate, day and night and urinary retention. It is estimated that approximately 300,000 men aged over 50 in Ireland, that is 30% of men in this age group, suffer from symptoms of an enlarged prostate[[2]].
UroLift is a minimally-invasive procedure, typically requiring 6-20 minutes (depending on the number of implants required), UroLift implants act like window curtain tie-backs to hold the lobes of an enlarged prostate open. A pilot scheme trialing the UroLift System at TUH in 2017 was deemed to be “very successful” by patients and hospital staff.
In my view, it is a truly transformative technology and can replace at least half of traditional operations to remove prostate tissue and if rolled out in other hospitals would have a very positive impact for the patients on waiting lists, significantly improving the lives of patients affected by this very common condition.”
Mr. Manecksha says: "I was very proud that TUH was the first public facility to pilot and now offer UroLift to our patients. Published data about the UroLift device and the experience of public healthcare systems globally has demonstrated the treatment’s potential to help tackle waiting lists, theatre and ward capacity challenges. In my view, it is a truly transformative technology and can replace at least half of traditional operations to remove prostate tissue and if rolled out in other hospitals would have a very positive impact for the patients on waiting lists, significantly improving the lives of patients affected by this very common condition.”
“The Hospital has long tradition of introducing pioneering treatment, the introduction of this new treatment underlines TUH’s location as a major urology centre. As the Hospital prepares to open a new elective day surgical centre offsite that will provide us with four additional operating theatres and 22 day case beds UroLift is the type of pioneering day case surgery that will enable us to treat thousands of patients a year, dramatically reducing waiting times and the need for recurrent NTPF funding support commented Prof Paul Ridgway, Perioperative Director and Consultant Upper GI, HPB & General Surgeon at TUH.
PATIENT CASE STUDY
Dave, a 70 year old man and one of the first patients to have the non-invasive procedure for BPH carried out, is a new man. Having an enlarged prostate meant every journey out of the house for him was planned to have access to toilet facilities at all times. The urgency to go to the toilet caused him considerable distress. Prior to the procedure, Dave was on medication, this helped somewhat but the symptoms were still there albeit not as often.
“Knowing that you need to be near a toilet every 30 minutes restricts your freedom to be out and about with your hobbies, it takes away any spontaneity you would have in your daily living. Whilst I wanted something done to fix the problem I was not overly keen at the thoughts of surgery, having to stay in Hospital never mind the associated risks like incontinence and perhaps causing other problems or having associated unknown side effects.
The UroLift procedure was the best of both worlds i.e. a solution to the problem, no general or spinal anaesthetic, no overnight stay in hospital and a reduced risk of side effects. I was actually in and out of the hospital in one morning so I could sleep in my own bed that night. The first few times passing water was uncomfortable - later that day this eased. I no longer need to take medication, I sleep the night through but more importantly I now have the freedom to go where I like when I like so I am back to my hobbies and living life.”
Data from clinical trials shows that patients receiving the UroLift System treatment reported rapid improvement in urinary symptoms and flow rate, while not experiencing new onset, sustained sexual dysfunction, an otherwise common side effect of traditional surgery. Patients also experienced a significant improvement in quality of life.
Some of the Key Benefits of the UroLift System treatment are:
Quicker recovery times: men are usually discharged within a few hours, typically without a catheter, reducing the risk of urinary tract infections; and they get back to normal activity quickly without the need for ongoing medication. One patient on the pilot scheme said the difference in his quality of life within two weeks was “fantastic”.
Reduced risk of surgical complications such as haemorrhage: a common event that remains a risk even days after traditional surgery[[3]].
0% risk of new onset sexual dysfunction: the treatment relieves lower urinary tract symptoms without the risk to sexual function posed by all other surgical options.
Shorter hospital stay: the procedure is performed as a day case using a combination of sedation and local anaesthetic – all patients on the Tallaght pilot scheme reported the procedure was “comfortable” while it was being carried out.
About Benign Prostatic Hyperplasia (BPH)
BPH, also known as enlarged prostate, is a medical condition in which the prostate gland that surrounds the male urethra becomes enlarged with advancing age and begins to obstruct the urinary system. BPH symptoms include sleepless nights and urinary problems, and can cause loss of productivity, depression and decreased quality of life.
Medication is often the first-line therapy for enlarged prostate, but relief can be inadequate and temporary. Side effects of treatment can include sexual dysfunction, dizziness and headaches, prompting many patients to quit using the drugs. For these patients, the classic alternative is surgery that cuts or ablates prostate tissue to open the blocked urethra. While current surgical options, such as TURP, can be very effective in relieving symptoms, it can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction and retrograde ejaculation (dry orgasm).
About Professor Rustom Manecksha
Consultant Urological Surgeon at TUH, and Clinical Senior Lecturer, Trinity College, Dublin, was involved in a multinational trial of the UroLift device seven years ago when he worked in Australia. He is a graduate of the School of Medicine in UCD. He completed his basic and higher surgical training in Ireland before embarking on a sub-specialty Fellowship in Melbourne, Australia. He has a special interest in endourology, kidney stone disease, BPH, minimal access renal surgery and prostate cancer. He is a keen researcher and has an active clinical research profile, as well as close links with the Institute of Molecular Medicine, Trinity Centre for Health Sciences.
About Tallaght University Hospital
TUH is one of Ireland’s largest acute teaching hospitals, adult, psychiatric and age-related healthcare on one site. The Hospital has 495 adult beds with 3,000 people on staff. The Hospital is a provider of local, regional and national specialties. It is also a national urology centre, the second largest provider of dialysis services in the country and a regional orthopaedic trauma centre. The Hospital also has 67 paediatric beds under the governance of Children’s Health Ireland and 52 mental health beds under HSE governance.
TUH is one of the two main teaching hospitals of Trinity College Dublin - specialising in the training and professional development of staff in areas such as nursing, health and social care professionals, emergency medicine and surgery, amongst many others. TUH is part of the Dublin Midlands Hospital Group which serves a population of over 1.2 million across seven counties.
A new satellite centre is to be built at TUH as part of the National Children’s Hospital project as a key element of an integrated clinical network for paediatric services nationally. The Hospital’s Emergency Departments catered for 51,084 Adult Attendance and 32,424 Paediatric Attendance in 2018. A further 293,751 patients were treated through the Hospital’s Adult and Paediatric outpatient clinics in 2018. The Hospital’s operations are supported by 200 general practitioners in surrounding communities and aligned with CHO7.
