Transperineal laser ablation (TPLA) can be used to treat lower urinary tract symptoms of benign prostatic hyperplasia in the NHS while more evidence is generated, in people who cannot have transurethral resection of the prostate (TURP) or other transurethral procedures. It can only be used with special arrangements for clinical governance, consent, and audit or research.
Clinicians wanting to do this procedure should:
Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
More research is needed on TPLA to treat lower urinary tract symptoms of benign prostatic hyperplasia in people who can have TURP or other transurethral procedures, before it can be used in the NHS.
This procedure should only be done as part of a formal research study and a research ethics committee needs to have approved its use.
Evidence generation and more research is needed on:
patient selection
longer-term outcomes, including reintervention rates.
Why the committee made these recommendations
There is not enough good-quality evidence on the safety and efficacy of this procedure. Most of the evidence is from small observational studies with short follow up. There are no major safety concerns and the procedure appears to improve symptoms, but more evidence is needed.
Benign prostatic hyperplasia is a common condition, particularly in older people. It is unclear whether this procedure works as well as other surgical procedures, but there may be fewer side effects. There are some people who cannot have transurethral procedures who could benefit from this procedure, so it can be used with special arrangements for these people. It should be used only in research when a transurethral procedure is an alternative.