Steam Treatment Approval for Enlarged Prostate

Peter Russell

August 21, 2018

A form of steam treatment to reduce the size of an enlarged prostate has been approved for routine use on the NHS in England.

The technique is called transurethral water vapour ablation for lower urinary tract symptoms caused by benign (non-cancerous) prostatic hyperplasia.

Interventional procedures guidance published by the National Institute for Health and Care Excellence (NICE) said the procedure, which is usually done as a day-case, could be an alternative to other treatments, including surgery.

The condition commonly affects men over 50, many of whom do not seek treatment for it.

Stromal and epithelial cells increase in number, causing the prostate to increase in size, compressing the urethra. Symptoms include inability to fully empty the bladder and an interrupted or decreased urine stream.

Steam Treatment Could Help Some Men Avoid Surgery

Current treatment options include medication, including alpha-blockers and 5-alpha-reductase inhibitors. In cases where treatments do not work, there is a range of surgical options including transurethral resection of the prostate (TURP). However, possible side effects of surgery include bleeding, infection, urethral strictures, incontinence, and sexual dysfunction.

Transurethral water vapour ablation involves inserting a retractable needle into the prostate to deliver 8 to 10 second bursts of steam at approximately 103C. At the same time, saline irrigation is used to cool and protect the surface of the urethra. The heat disrupts cell membranes in the prostate, leading to rapid cell death. The needle is retracted and repositioned several times so the procedure can be repeated in different areas of the gland.

Reducing the size of the prostate in this way leads to improvement in lower urinary tract symptoms after between 1 to 3 months, without impairing sexual function.

Patients may have to take antibiotics and have a urinary catheter for some days after the procedure. They are advised to avoid some activities, including sexual intercourse, for up to one month.

'Safe and Effective': NICE

To reach its decision, NICE reviewed published literature on the efficacy and safety of this procedure, including one controlled trial. The views of 15 patients were also taken into consideration.

The procedure should only be done by a urologist with specific training in the procedure, who should carry out their initial procedures with an experienced mentor, NICE said.

Prof Kevin Harris, programme director and clinical advisor for the Interventional Procedures Programme at NICE, said: "This treatment is one of a number of options that are effective and safe for benign prostatic hyperplasia.

"Approving this procedure gives men the chance to talk to their clinician about which is right for them."

NICE guidance: Transurethral water vapour ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia. Guidance.


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