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姜宜妮 攝護腺肥大新治療Urolift:英國國家健康治療指引研究 2023/8/14 下午 04:09:44 0
原 文 題  目 UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance
作  者 Laura Knight et al.
出  處 Appl Health Econ Health Policy.
出版日期 2022 Sep
評 論

攝護腺肥大導致男性排尿儲尿的下尿路症狀。治療包括經尿道電燒刮除攝護腺,雷射剜除攝護腺,與Urolift壓縮攝護腺。Urolift藉由植入物壓縮多餘的攝護腺組織,使尿道得以不再被攝護腺壓迫,保持暢通。此方式不需要切除攝護腺組織,因而減少出血與併發症,於2015年被納入英國國家健康指引。經觀察至2021年,數個研究顯示與其他治療相比,此治療改善排尿分數略遜於傳統手術,然而對勃起與射精的影響相對很小,為對性功能考量較多的男性朋友一個相對安全的治療選擇。

abstract

Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30-80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.

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