The document discusses the introduction and clinical evidence for the UroLift system, a minimally invasive treatment for benign prostatic hyperplasia (BPH). It summarizes the clinical trials demonstrating UroLift's rapid and durable relief of BPH symptoms with minimal side effects. It also outlines UroLift's journey to approval and reimbursement in the UK, including a positive NICE recommendation and being granted an Innovation Technology Tariff to facilitate adoption in the NHS. UroLift is positioned as a cost-effective alternative to traditional BPH surgeries that allows for quicker recovery and preservation of sexual function.
This document discusses benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms. It notes that current treatments for BPH, including drug therapy and surgery, have significant downsides. Surgery requires general anesthesia and hospitalization, and has risks of complications like erectile dysfunction. Many patients still experience symptoms after surgery or require readmission. This places a high financial burden on healthcare systems. The document introduces prostatic urethral lift as a new minimally invasive treatment for BPH that does not require cutting or removing tissue. It aims to provide quick and durable relief of symptoms without the side effects of other treatments. Evidence suggests it allows same-day discharge and has a low risk of sexual dysfunction or
This document discusses prostatic urethral lift (Urolift), a minimally invasive treatment for benign prostatic hyperplasia (BPH). Urolift involves inserting permanent implants through the urethra that compress the prostate without removing tissue. It provides rapid symptom relief with no risk of sexual or urinary dysfunction. Urolift is best for mild to moderate BPH symptoms and men who prefer to avoid medications. While effective for most, 10-30% of men may still require medications or additional procedures after Urolift. Side effects are usually mild and transient.
Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate...Max Peters
This document discusses a study comparing urethral and bladder dosimetry and rates of late genitourinary (GU) toxicity between focal salvage (FS) and total salvage (TS) Iodine-125 brachytherapy (I-125-BT) for recurrent prostate cancer. FS I-125-BT significantly reduces dose to the urethra and bladder compared to TS. Late severe (grade 3 or higher) GU toxicity occurred in 38% of TS patients versus one case in the FS group. For TS patients, bladder D2cc of less than 70 Gy and urethral V100 of less than 0.40 cc were identified as dose constraints associated with reducing late GU toxicity
This document discusses the role of chemotherapy and radiotherapy in treating carcinoma of the bladder. It provides details on neoadjuvant chemotherapy, adjuvant chemotherapy, radical radiotherapy, and combined modality treatment for locally advanced disease. Neoadjuvant chemotherapy is found to improve survival outcomes compared to cystectomy alone by treating micrometastases. For metastatic bladder cancer, platinum-based regimens such as cisplatin and gemcitabine remain the standard first-line treatment. Radiotherapy can be used for organ-sparing treatment in select patients or as adjuvant therapy before or after surgery.
This document provides information on muscle invasive bladder cancer including:
- Risk factors like smoking which causes 50-65% of male cases. Quitting smoking reduces risk.
- Neoadjuvant chemotherapy like MVAC or GC improves survival by 5-8% by reducing micrometastatic disease burden.
- Radical cystectomy is the gold standard but bladder preservation with trimodality therapy of TURBT followed by chemoradiation is also used, achieving 50-82% 5-year cancer specific survival.
- Adjuvant chemotherapy is recommended for pT3/4 or pN+ disease without neoadjuvant chemotherapy. MVAC and GC are standard first-line regimens
I have uploaded the presentation on Yttrium 90 & its application in treatment of Liver Cancer. Presentation elaborates on characteristics of Y-90, how treatment is planned, workup done & aspects on radiation safety & post treatment care. I would be glad to answer queries on this new emerging exciting area of treating Inoperable Liver Cancers.
This document discusses benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms. It notes that current treatments for BPH, including drug therapy and surgery, have significant downsides. Surgery requires general anesthesia and hospitalization, and has risks of complications like erectile dysfunction. Many patients still experience symptoms after surgery or require readmission. This places a high financial burden on healthcare systems. The document introduces prostatic urethral lift as a new minimally invasive treatment for BPH that does not require cutting or removing tissue. It aims to provide quick and durable relief of symptoms without the side effects of other treatments. Evidence suggests it allows same-day discharge and has a low risk of sexual dysfunction or
This document discusses prostatic urethral lift (Urolift), a minimally invasive treatment for benign prostatic hyperplasia (BPH). Urolift involves inserting permanent implants through the urethra that compress the prostate without removing tissue. It provides rapid symptom relief with no risk of sexual or urinary dysfunction. Urolift is best for mild to moderate BPH symptoms and men who prefer to avoid medications. While effective for most, 10-30% of men may still require medications or additional procedures after Urolift. Side effects are usually mild and transient.
Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate...Max Peters
This document discusses a study comparing urethral and bladder dosimetry and rates of late genitourinary (GU) toxicity between focal salvage (FS) and total salvage (TS) Iodine-125 brachytherapy (I-125-BT) for recurrent prostate cancer. FS I-125-BT significantly reduces dose to the urethra and bladder compared to TS. Late severe (grade 3 or higher) GU toxicity occurred in 38% of TS patients versus one case in the FS group. For TS patients, bladder D2cc of less than 70 Gy and urethral V100 of less than 0.40 cc were identified as dose constraints associated with reducing late GU toxicity
This document discusses the role of chemotherapy and radiotherapy in treating carcinoma of the bladder. It provides details on neoadjuvant chemotherapy, adjuvant chemotherapy, radical radiotherapy, and combined modality treatment for locally advanced disease. Neoadjuvant chemotherapy is found to improve survival outcomes compared to cystectomy alone by treating micrometastases. For metastatic bladder cancer, platinum-based regimens such as cisplatin and gemcitabine remain the standard first-line treatment. Radiotherapy can be used for organ-sparing treatment in select patients or as adjuvant therapy before or after surgery.
This document provides information on muscle invasive bladder cancer including:
- Risk factors like smoking which causes 50-65% of male cases. Quitting smoking reduces risk.
- Neoadjuvant chemotherapy like MVAC or GC improves survival by 5-8% by reducing micrometastatic disease burden.
- Radical cystectomy is the gold standard but bladder preservation with trimodality therapy of TURBT followed by chemoradiation is also used, achieving 50-82% 5-year cancer specific survival.
- Adjuvant chemotherapy is recommended for pT3/4 or pN+ disease without neoadjuvant chemotherapy. MVAC and GC are standard first-line regimens
I have uploaded the presentation on Yttrium 90 & its application in treatment of Liver Cancer. Presentation elaborates on characteristics of Y-90, how treatment is planned, workup done & aspects on radiation safety & post treatment care. I would be glad to answer queries on this new emerging exciting area of treating Inoperable Liver Cancers.
1. Several randomized controlled trials have consistently shown that the addition of neoadjuvant hormonal therapy (NHT) to external beam radiotherapy (EBRT) improves outcomes for men with intermediate-risk or high-risk localized prostate cancer.
2. The optimal timing and duration of NHT is still unclear, but most evidence suggests that 2-3 months of NHT combined with EBRT is adequate for intermediate-risk patients. Longer adjuvant hormonal therapy may benefit high-risk patients.
3. While the sequence of NHT relative to EBRT may impact outcomes, short-term NHT combined with EBRT appears beneficial overall based on multiple randomized trials.
Neoadjuvant Chemotherapy in muscle invasive bladder cancer:The Standard of ...Diaa A. Hameed
This document discusses the evidence for neoadjuvant chemotherapy (NAC) as the standard of care for muscle-invasive bladder cancer (MIBC). It summarizes several key studies that have demonstrated the benefits of NAC, including improved survival rates and decreased risk of death. One study showed a 13% reduction in mortality and 5% improvement in 5-year survival. Later studies provided longer-term data showing ongoing survival benefits up to 10 years later. The document also addresses concerns about NAC delaying surgery or exhausting patients, but cites evidence it does not increase perioperative risks or prevent planned cystectomy. It presents cases from the author's own study demonstrating response rates to NAC. In the end, it questions how
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). It outlines the trimodality approach of maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiation. Studies have shown 5-year bladder intact survival rates ranging from 36-66% with this approach. Complete response to induction chemoradiation may allow bladder preservation. Radical cystectomy is associated with significant morbidity while bladder preservation maintains quality of life. Long-term outcomes depend on patient selection and a multidisciplinary approach can maximize organ preservation while achieving high cure rates.
Non-muscle-invasive bladder cancer is typically treated with transurethral resection of bladder tumors (TURBT) to diagnose, stage, and remove visible tumors, followed by intravesical chemotherapy or immunotherapy to prevent recurrence depending on risk level. Bacillus Calmette-Guerin (BCG) immunotherapy is recommended for high-risk non-muscle-invasive bladder cancer to elicit an immune response against tumor cells. Patients undergo cystoscopy surveillance following treatment to monitor for recurrence.
Selective internal radiation therapy for the treatment of liver cancerYasoba Atukorale
This document summarizes selective internal radiation therapy (SIRT) for treating liver cancer. SIRT involves delivering microspheres containing the radioactive isotope yttrium-90 to the liver tumor via injection into the hepatic artery. It is an emerging treatment for primary or metastatic liver cancers that cannot be surgically removed. Liver cancer incidence is increasing in Australia, creating a growing clinical need for new treatment options like SIRT, which has been approved for use in Australia and is being used or tested in many countries around the world.
This document discusses treatment approaches for bladder cancer including radiotherapy and cystectomy. It summarizes results from several studies comparing outcomes of radiotherapy versus cystectomy, and studies combining radiotherapy with chemotherapy. The key findings are:
1) Long-term survival rates after radiotherapy or cystectomy are comparable.
2) A study found neoadjuvant chemotherapy prior to radiotherapy improved 2-year loco-regional disease-free survival compared to radiotherapy alone.
3) Bladder preserving therapy can provide good long-term bladder function for patients who are not candidates for cystectomy.
Meningiomas are the most common primary brain tumors. They arise from arachnoid cap cells in the brain. The study analyzes patients with Grade 1 meningiomas treated with stereotactic radiotherapy (SRT) and compares outcomes to conventional radiation therapy. Median follow up was 3.5 years. Meningioma specific survival was 84.6%, progression free survival was 69.2%, and disease free survival was also 84.6%, arguing that SRT is comparable to conventional radiation for small Grade 1 meningiomas. Early adjuvant SRT after surgery appeared to have better response than treatment during recurrence.
SIR-Spheres microspheres are a medical device used in selective internal radiation therapy (SIRT) to treat metastatic colorectal cancer in the liver. SIRT involves injecting radioactive microspheres into the hepatic artery to lodge in the blood vessels surrounding tumors and deliver radiation directly to the tumors to destroy cancer cells while sparing healthy liver tissue. Potential mild side effects include abdominal pain, nausea, fever and fatigue that typically subside within a few weeks. SIRT is an outpatient procedure that takes about an hour and patients are monitored for several hours after treatment.
This document provides an overview of interventional radiology procedures including examples of treating liver cancer, blood clots, and infections. It describes how interventional radiology uses imaging guidance like ultrasound, CT, and MRI to perform minimally invasive procedures using needles and catheters. Specific procedures discussed include angioplasty and stenting to open narrowed arteries, embolization to close bleeding arteries, chemoembolization to deliver chemotherapy directly to tumors via arteries, removing blood clots, biopsy of organs, tumor ablation, and draining abscesses. Case examples provided include using chemoembolization to treat a patient's liver cancer and thrombolysis to treat a patient's deep vein thrombosis.
Radioembolization of Hepatic Metastases with Yttrium 90 (1) (1) FINALBrandon Wright
This document discusses radioembolization with Yttrium-90 as a treatment for hepatic metastases caused by colorectal cancer. It provides background on the disease, current treatment options, and rationale for using radioembolization. Radioembolization involves administering Yttrium-90 microspheres via the hepatic artery to target tumor cells. The document reviews patient selection criteria, outcomes from clinical trials showing median survival of 15.5 months, and potential adverse effects including nausea, abdominal pain and fatigue.
This document discusses multimodality treatments for locally advanced prostate cancer, including combining radiotherapy with androgen deprivation therapy or chemotherapy. It reviews randomized trials showing radiotherapy plus androgen deprivation is standard treatment. It also discusses investigating neoadjuvant, concurrent, or adjuvant chemotherapy or targeted therapies with radiotherapy to better treat micrometastatic disease and modify tumor radiosensitivity or microenvironment. Several agents targeting DNA repair, angiogenesis, hypoxia, and PI3K/AKT/mTOR pathways are discussed. Improving results may involve targeting the tumor and microenvironment with surgery and radiotherapy also discussed.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
This document summarizes guidelines and techniques for partial nephrectomy. It discusses:
1. Indications for partial nephrectomy based on AUA guidelines.
2. Patient positioning and port placement techniques.
3. Methods for renal cooling, clamping techniques, and the debate around mannitol use.
4. Techniques for complex tumors like hilar and endophytic lesions, including the use of intraoperative ultrasound.
Open partial nephrectomy is the gold standard approach for small renal masses (SRM). A study comparing 100 patients who underwent laparoscopic partial nephrectomy (Lap) to 100 who underwent open partial nephrectomy (Open) found that despite tumors being significantly larger in the Open group, ischemia time was significantly shorter in Open. Intraoperative complications were nil in Open but 5% in Lap. Lap had significantly prolonged ischemia time and more postoperative complications, though operative time was shorter. While outcomes were comparable, the learning curve for Lap is very long and it is relatively contraindicated for complex cases.
Kupelian 1st talk planning dose hyderabad 2013 (cancer ci 2013) patrick kupel...Dr. Vijay Anand P. Reddy
This document discusses radiotherapy treatment for localized prostate cancer. It begins by outlining prostate anatomy and imaging, including the importance of MRI. It then reviews competing treatment modalities like surgery and surveillance. A key topic is the importance of dose escalation in radiotherapy, as higher doses above 75 Gy have been shown to improve outcomes. Technique aspects covered include treatment planning with IMRT, dose constraints for organs at risk, and methods for dose escalation through conventional fractionation, hypofractionation, or stereotactic body radiosurgery. Patient-reported toxicity is also addressed.
This document discusses radiotherapy (RT) for hepatocellular carcinoma (HCC) in the Asia-Pacific region. It compares outcomes between sorafenib and RT for intermediate/advanced HCC. Helical tomotherapy (HT) improves long-term survival and increases radiation dose without increased toxicity for HCC with macrovascular invasion compared to 3D conformal radiotherapy (3DCRT). HT allows delivery of higher radiation doses in a shorter treatment period with acceptable toxicity for HCC with macrovascular invasion.
This document discusses treatment options for hepatocellular carcinoma (HCC), focusing on transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). It stratifies HCC using the Barcelona criteria and examines prognostic factors. For intermediate stage HCC, TACE is the standard treatment and can provide 1, 2, and 3 year survival rates of 57%, 31%, and 26% respectively. Newer techniques like drug-eluting bead TACE may have fewer side effects than conventional TACE. RFA provides the best results for tumors under 3cm, with a 5 year survival of 40-70% for eligible patients. The document compares various locoregional therapies and their roles based on
ECO10 - Digital roadmap for Lancashire and South CumbriaInnovation Agency
This document outlines digital enablers to support the strategic transformation plan (STP) in primary care, community care, and hospitals. It discusses using digital tools to: 1) increase capacity in primary care through telehealth, apps, and online tools; 2) manage demand through online services, triage tools, and electronic referrals; and 3) avoid hospital admissions by integrating data, developing risk algorithms, and deploying remote monitoring and telehealth solutions. It also covers using digital discharge solutions, shared records, and near-patient testing to enable early discharge; developing prevention apps and health coaching; and driving efficiency through back office digitization and workforce digital skills training.
ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest modelInnovation Agency
The Liverpool model focuses on improving patient experience and efficiency in the cath lab through a lounge model. Originally starting as a 5 patient lounge trial costing £3000, it has expanded to a 25 patient Holly Suite lounge with only 6 trolleys, offering patients amenities like beverages, massage, and internet access while waiting in their own clothes. Key aspects include interactive scheduling, staggered admissions, no fasting or recovery period, and same-day discharge. Divisional control and collaboration between the Holly Suite and cath lab have been keys to progress, with further developments planned like RFID tagging and an integrated digital system.
1. Several randomized controlled trials have consistently shown that the addition of neoadjuvant hormonal therapy (NHT) to external beam radiotherapy (EBRT) improves outcomes for men with intermediate-risk or high-risk localized prostate cancer.
2. The optimal timing and duration of NHT is still unclear, but most evidence suggests that 2-3 months of NHT combined with EBRT is adequate for intermediate-risk patients. Longer adjuvant hormonal therapy may benefit high-risk patients.
3. While the sequence of NHT relative to EBRT may impact outcomes, short-term NHT combined with EBRT appears beneficial overall based on multiple randomized trials.
Neoadjuvant Chemotherapy in muscle invasive bladder cancer:The Standard of ...Diaa A. Hameed
This document discusses the evidence for neoadjuvant chemotherapy (NAC) as the standard of care for muscle-invasive bladder cancer (MIBC). It summarizes several key studies that have demonstrated the benefits of NAC, including improved survival rates and decreased risk of death. One study showed a 13% reduction in mortality and 5% improvement in 5-year survival. Later studies provided longer-term data showing ongoing survival benefits up to 10 years later. The document also addresses concerns about NAC delaying surgery or exhausting patients, but cites evidence it does not increase perioperative risks or prevent planned cystectomy. It presents cases from the author's own study demonstrating response rates to NAC. In the end, it questions how
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). It outlines the trimodality approach of maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiation. Studies have shown 5-year bladder intact survival rates ranging from 36-66% with this approach. Complete response to induction chemoradiation may allow bladder preservation. Radical cystectomy is associated with significant morbidity while bladder preservation maintains quality of life. Long-term outcomes depend on patient selection and a multidisciplinary approach can maximize organ preservation while achieving high cure rates.
Non-muscle-invasive bladder cancer is typically treated with transurethral resection of bladder tumors (TURBT) to diagnose, stage, and remove visible tumors, followed by intravesical chemotherapy or immunotherapy to prevent recurrence depending on risk level. Bacillus Calmette-Guerin (BCG) immunotherapy is recommended for high-risk non-muscle-invasive bladder cancer to elicit an immune response against tumor cells. Patients undergo cystoscopy surveillance following treatment to monitor for recurrence.
Selective internal radiation therapy for the treatment of liver cancerYasoba Atukorale
This document summarizes selective internal radiation therapy (SIRT) for treating liver cancer. SIRT involves delivering microspheres containing the radioactive isotope yttrium-90 to the liver tumor via injection into the hepatic artery. It is an emerging treatment for primary or metastatic liver cancers that cannot be surgically removed. Liver cancer incidence is increasing in Australia, creating a growing clinical need for new treatment options like SIRT, which has been approved for use in Australia and is being used or tested in many countries around the world.
This document discusses treatment approaches for bladder cancer including radiotherapy and cystectomy. It summarizes results from several studies comparing outcomes of radiotherapy versus cystectomy, and studies combining radiotherapy with chemotherapy. The key findings are:
1) Long-term survival rates after radiotherapy or cystectomy are comparable.
2) A study found neoadjuvant chemotherapy prior to radiotherapy improved 2-year loco-regional disease-free survival compared to radiotherapy alone.
3) Bladder preserving therapy can provide good long-term bladder function for patients who are not candidates for cystectomy.
Meningiomas are the most common primary brain tumors. They arise from arachnoid cap cells in the brain. The study analyzes patients with Grade 1 meningiomas treated with stereotactic radiotherapy (SRT) and compares outcomes to conventional radiation therapy. Median follow up was 3.5 years. Meningioma specific survival was 84.6%, progression free survival was 69.2%, and disease free survival was also 84.6%, arguing that SRT is comparable to conventional radiation for small Grade 1 meningiomas. Early adjuvant SRT after surgery appeared to have better response than treatment during recurrence.
SIR-Spheres microspheres are a medical device used in selective internal radiation therapy (SIRT) to treat metastatic colorectal cancer in the liver. SIRT involves injecting radioactive microspheres into the hepatic artery to lodge in the blood vessels surrounding tumors and deliver radiation directly to the tumors to destroy cancer cells while sparing healthy liver tissue. Potential mild side effects include abdominal pain, nausea, fever and fatigue that typically subside within a few weeks. SIRT is an outpatient procedure that takes about an hour and patients are monitored for several hours after treatment.
This document provides an overview of interventional radiology procedures including examples of treating liver cancer, blood clots, and infections. It describes how interventional radiology uses imaging guidance like ultrasound, CT, and MRI to perform minimally invasive procedures using needles and catheters. Specific procedures discussed include angioplasty and stenting to open narrowed arteries, embolization to close bleeding arteries, chemoembolization to deliver chemotherapy directly to tumors via arteries, removing blood clots, biopsy of organs, tumor ablation, and draining abscesses. Case examples provided include using chemoembolization to treat a patient's liver cancer and thrombolysis to treat a patient's deep vein thrombosis.
Radioembolization of Hepatic Metastases with Yttrium 90 (1) (1) FINALBrandon Wright
This document discusses radioembolization with Yttrium-90 as a treatment for hepatic metastases caused by colorectal cancer. It provides background on the disease, current treatment options, and rationale for using radioembolization. Radioembolization involves administering Yttrium-90 microspheres via the hepatic artery to target tumor cells. The document reviews patient selection criteria, outcomes from clinical trials showing median survival of 15.5 months, and potential adverse effects including nausea, abdominal pain and fatigue.
This document discusses multimodality treatments for locally advanced prostate cancer, including combining radiotherapy with androgen deprivation therapy or chemotherapy. It reviews randomized trials showing radiotherapy plus androgen deprivation is standard treatment. It also discusses investigating neoadjuvant, concurrent, or adjuvant chemotherapy or targeted therapies with radiotherapy to better treat micrometastatic disease and modify tumor radiosensitivity or microenvironment. Several agents targeting DNA repair, angiogenesis, hypoxia, and PI3K/AKT/mTOR pathways are discussed. Improving results may involve targeting the tumor and microenvironment with surgery and radiotherapy also discussed.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
This document summarizes guidelines and techniques for partial nephrectomy. It discusses:
1. Indications for partial nephrectomy based on AUA guidelines.
2. Patient positioning and port placement techniques.
3. Methods for renal cooling, clamping techniques, and the debate around mannitol use.
4. Techniques for complex tumors like hilar and endophytic lesions, including the use of intraoperative ultrasound.
Open partial nephrectomy is the gold standard approach for small renal masses (SRM). A study comparing 100 patients who underwent laparoscopic partial nephrectomy (Lap) to 100 who underwent open partial nephrectomy (Open) found that despite tumors being significantly larger in the Open group, ischemia time was significantly shorter in Open. Intraoperative complications were nil in Open but 5% in Lap. Lap had significantly prolonged ischemia time and more postoperative complications, though operative time was shorter. While outcomes were comparable, the learning curve for Lap is very long and it is relatively contraindicated for complex cases.
Kupelian 1st talk planning dose hyderabad 2013 (cancer ci 2013) patrick kupel...Dr. Vijay Anand P. Reddy
This document discusses radiotherapy treatment for localized prostate cancer. It begins by outlining prostate anatomy and imaging, including the importance of MRI. It then reviews competing treatment modalities like surgery and surveillance. A key topic is the importance of dose escalation in radiotherapy, as higher doses above 75 Gy have been shown to improve outcomes. Technique aspects covered include treatment planning with IMRT, dose constraints for organs at risk, and methods for dose escalation through conventional fractionation, hypofractionation, or stereotactic body radiosurgery. Patient-reported toxicity is also addressed.
This document discusses radiotherapy (RT) for hepatocellular carcinoma (HCC) in the Asia-Pacific region. It compares outcomes between sorafenib and RT for intermediate/advanced HCC. Helical tomotherapy (HT) improves long-term survival and increases radiation dose without increased toxicity for HCC with macrovascular invasion compared to 3D conformal radiotherapy (3DCRT). HT allows delivery of higher radiation doses in a shorter treatment period with acceptable toxicity for HCC with macrovascular invasion.
This document discusses treatment options for hepatocellular carcinoma (HCC), focusing on transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). It stratifies HCC using the Barcelona criteria and examines prognostic factors. For intermediate stage HCC, TACE is the standard treatment and can provide 1, 2, and 3 year survival rates of 57%, 31%, and 26% respectively. Newer techniques like drug-eluting bead TACE may have fewer side effects than conventional TACE. RFA provides the best results for tumors under 3cm, with a 5 year survival of 40-70% for eligible patients. The document compares various locoregional therapies and their roles based on
ECO10 - Digital roadmap for Lancashire and South CumbriaInnovation Agency
This document outlines digital enablers to support the strategic transformation plan (STP) in primary care, community care, and hospitals. It discusses using digital tools to: 1) increase capacity in primary care through telehealth, apps, and online tools; 2) manage demand through online services, triage tools, and electronic referrals; and 3) avoid hospital admissions by integrating data, developing risk algorithms, and deploying remote monitoring and telehealth solutions. It also covers using digital discharge solutions, shared records, and near-patient testing to enable early discharge; developing prevention apps and health coaching; and driving efficiency through back office digitization and workforce digital skills training.
ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest modelInnovation Agency
The Liverpool model focuses on improving patient experience and efficiency in the cath lab through a lounge model. Originally starting as a 5 patient lounge trial costing £3000, it has expanded to a 25 patient Holly Suite lounge with only 6 trolleys, offering patients amenities like beverages, massage, and internet access while waiting in their own clothes. Key aspects include interactive scheduling, staggered admissions, no fasting or recovery period, and same-day discharge. Divisional control and collaboration between the Holly Suite and cath lab have been keys to progress, with further developments planned like RFID tagging and an integrated digital system.
The Countess of Chester Hospital implemented a patient and asset tracking system using RFID tags to monitor patients and equipment in real-time. The system utilizes wireless networks, infrared transmitters, and individual tags for over 9,000 patients, staff, and devices. It provides live dashboard displays of bed status, theatre capacity, and other metrics to help coordinate patient flow, optimize asset usage, and improve efficiency across the hospital system. The tracking data and coordination center allow staff to view bed availability, automate workflows, and better manage admissions and discharges.
Your patients want to help you get better - James Munro, Patient OpinionInnovation Agency
The document discusses how patients want to provide feedback to help healthcare providers improve their services. It shares quotes from healthcare professionals who have found patient feedback on Patient Opinion valuable for understanding what they can change. The world is shifting from old hierarchical models to new networked models where patients can actively participate rather than just passively receive care. The document ends by quoting a report recommending healthcare organizations hear the patient voice at all levels.
Amanda Ricchiuti of Blackpool Care Home Support Team presneted the work of this team who have been monitoring local care homes using telehealth equipment to prevent admissions to hospital.
The document provides information about the SBRI Healthcare Programme, which is an NHS England funded initiative that uses innovation to help address challenges in the public sector healthcare system. It outlines key features of the SBRI process, including that it provides 100% funded R&D contracts for innovative suppliers to engage with the public sector. It notes upcoming competitions through the programme, including ones focused on improving patient flow and operational efficiency in acute care settings, and developing tools to support self-care and independence for children with long-term conditions. Contact details are provided for those interested in learning more or applying to the programme.
This document discusses the implementation of electronic referrals and resource matching software across health and social care providers in Cumbria to improve patient flow and resource utilization. It provides examples of the annual savings and efficiencies achieved through reducing paperwork and wait times. Specifically, it highlights how University Hospitals of Morecambe Bay has integrated their electronic patient record system with the referral software to allow fully electronic transmission of referrals and tracking of patient progress between providers. Feedback from staff emphasizes improvements in communication, data quality and joint working between health and social care since implementing the electronic referral system.
Using social media to engage communities and consult - Alex TalbottInnovation Agency
This document discusses using social media to engage communities and conduct consultations. It outlines statutory duties for NHS organizations and clinical commissioning groups to involve the public. It then discusses how social media can help with involvement, participation, engagement and co-commissioning through two-way and open communication. It provides examples of owned, earned and paid online channels that can be used, and emphasizes prioritizing the channels where target audiences are. It gives tips on focusing on communities of interest, using the right lexicon, showing empathy, handling negativity, and allocating appropriate resources.
ECO 11: Centre for Pharmacy Innovation - Professor Alison EwingInnovation Agency
Professor Alison Ewing introduces the Centre for Pharmacy Innovation, a collaboration between Liverpool John Moores University, Royal Liverpool and Broadgreen University Hospitals, and Lloyds Pharmacy.
Kate Norman discusses using social media as a tool for engaging staff, creating communities and empowering them to become users at all levels of the NHS.
Driving new ways of working through Connected Health Ecosystems - Damian O'Co...Innovation Agency
Damian O'Connor discusses how the European Connected Health Alliance is driving news ways of working through connected health ecosystems. O'Connor's presentation introduces the basic principles of these ecosystems, the international network of ecosystems, and the ECHAlliance working groups one of which is a Medicines Optimisation Group.
Dr Liz Mear - Welcome to Ecosystem 11 - Digital Innovation in Medicines Optim...Innovation Agency
Dr Liz Mear, Chief Executive of the Innovation Agency, introduces the medicines optimisation programmes in the North West Coast region. She also talks about the role the Innovation Agency plays in the spread and adoption of innovation in healthcare using tools such as the Innovation Exchange and Putting Innovation into Practice.
EngageWell Introduction - Caroline Kenyon, Director of Communications, Innova...Innovation Agency
Caroline Kenyon from the Innovation Agency discusses why healthcare professionals should care about social media as an introduction to the EngageWell event.
Dr Stuart Berry explains how and why he uses social media as a GP, his experiences so far, and his suggestions and top tips for making the most of social media in a healthcare setting.
Impact of social media on patient information provision, networking and commu...Innovation Agency
The impact of using social media on patient information provision, networking and communication through the creation of the Greater Manchester Kidney Information Network (GMKIN) by the University of Salford. The presentation looks at the creation of GMKIN, its impact, case studies and success stories.
ECO10 - Wirral Hospital's journey to global digital excellenceInnovation Agency
- Wirral University Teaching Hospital (WUTH) has been a leader in digitized healthcare for over 20 years, implementing Cerner solutions across its systems starting in 2009.
- WUTH's digitized records system, called Wirral Millennium, supports functions like infection control, safeguarding, document retrieval, and has led to improvements in clinical outcomes.
- Going forward, WUTH aims to achieve a fully paperless hospital, integrate more medical devices, enhance communication across care settings, and develop population health analytics to support new care models.
Multiprofessional social media communities: improving health and care - Naomi...Innovation Agency
Naomi McVey highlights how multiprofessional social media communities are supporting improvements in health and care with examples and further thoughts for event attendees.
L’indagine urodinamica prima della chirurgia per IUS - PROGLUP2010
(1) A recent Cochrane review found that while urodynamic tests changed clinical decision making, there was no clear evidence it resulted in better patient outcomes. However, the review had limitations as it only included two small studies.
(2) A study of 523 women found that omitting urodynamics was not inferior to including it for preoperative evaluation of stress urinary incontinence. However, the study groups were imbalanced and subgroups like those with voiding dysfunction were not fully analyzed.
(3) Urodynamics can identify underlying conditions like detrusor overactivity that may not require surgery. Avoiding unnecessary surgeries through urodynamics could save costs when evaluating large numbers of patients
L’indagine urodinamica prima della chirurgia per IUS PROGLUP2010
(1) A recent Cochrane review found that while urodynamic tests changed clinical decision making, there was no clear evidence it led to better patient outcomes. However, the review had limitations as it only included two small studies.
(2) Urodynamic evaluation can identify underlying conditions like detrusor overactivity that may not require surgery. Avoiding unnecessary surgeries through urodynamics could save significant costs.
(3) Urodynamic tests can provide parameters to predict surgical success or complications and guide surgical technique selection, such as using retropubic slings for stress urinary incontinence patients with intrinsic sphincter deficiency.
This document summarizes the issues surrounding female urinary incontinence and the use of mesh. It notes that several governments and regulatory agencies have placed restrictions on transvaginal mesh due to inadequate evidence of long-term safety and efficacy and risk of harm. Studies show mesh can lead to complications like pain, infection, and erosion. Alternatives to mesh discussed include exercises, bulking agents, and new non-surgical therapies like BTL Emsella which uses electromagnetic stimulation of the pelvic floor muscles.
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Talk by Sir. Michael Brady, given at the Department of Computer Science, University of Cyprus.
Date: 24 June, 2015
This talk has two inter-twined aims. First, it introduces the medical challenges, and the science that is being developed to address those challenges, that underlie my (current) companies: Mirada Medical, Volpara Solutions, Perspectum Diagnostics, ScreenPoint bv, further illustrated by Guidance Navigation Holdings, IRISS Medical Technologies, and Acuitas Medical. Second, it asks why I am driven by the translation of mathematics and computing (white board) to clinical practice (white coats).
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1) The promise of precision medicine in tailoring treatments to a patient's specific biomarkers or genetic profile, leading to better outcomes. Examples are given of targeted therapies approved for lung cancer subtypes.
2) Best practices from other countries in implementing precision medicine, such as France's national network of molecular testing centers to ensure equal access. Challenges discussed include getting the right test to the right patient at the right time for the right price.
3) Recommendations to optimize precision medicine in the future, such as establishing molecular testing programs and guidelines to help integrate testing into clinical practice and minimize delays in treatment. Time
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Corrosive injury review article and management.pptxAsthaAmeta2
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Has cancer science got you stumped and overwhelmed? Leading gynecologic oncologist, Dr. Don Dizon, takes us to cancer college in this webinar. He explains the science behind ovarian cancer, how it develops, how it's diagnosed, and how ovarian cancer treatments work.
Similar to ECO10 - Measuring the true pathway of innovation in the NHS (20)
This document provides a summary of a presentation on statins. It discusses the benefits of statins in reducing cardiovascular events and mortality in both primary and secondary prevention. It addresses several controversies around statins, including their association with diabetes, cognitive impairment, cancer, and hemorrhagic stroke. While some modest risks are noted, the overall benefits of statins in reducing cardiovascular risk are found to outweigh these potential risks. The document emphasizes the importance of statin adherence to achieve optimal outcomes and addresses targets for LDL and non-HDL cholesterol levels according to recent guidelines.
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2) Data is presented on the percentage of virtual vs face-to-face appointments by specialty for different regions, showing variation between specialties and trusts in uptake of virtual appointments.
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Master slide deck from the Excel in Health webinar series: The NHS landscape presentation.
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The session will cover the following topics:
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The document discusses strategies for effective virtual collaboration using Zoom. It covers:
1. Getting familiar with basic Zoom functions and pushing boundaries to achieve results through techniques like choosing the right technology, managing time and atmosphere, addressing technical issues, and designing for inclusivity.
2. Methods for collecting data virtually through polling software, informal tools like chat and reactions, and creative approaches like using glass jars, mountains, push pins, and post-its for feedback.
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The document discusses restorative practices and community circles. It provides information on the core principles and processes of restorative circles, including their purposes, structural elements, characteristics, and stages. Circles are presented as an alternative to traditional hierarchical meetings and aim to allow all voices, build relationships, and develop understanding and solutions. Indigenous justice practices of restoration and healing are also honored.
The document outlines an agenda for a webinar hosted by the Innovation Scout network. It will include an introduction to the Innovation Scout network, a presentation from an advocacy link worker, a Q&A session, and wrap up. Attendees are encouraged to tweet with specific hashtags and email the contact for follow up discussions. The Innovation Scout network is a community of practice that was relaunched in 2019 to support innovation in health and social care through tools, culture change, entrepreneurial skills development, and networking. It has over 80 members across the North West Coast region working on healthcare innovation.
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Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
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The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
ECO10 - Measuring the true pathway of innovation in the NHS
1. Measuring the true pathway of
innovation into the NHS
UroLift® – A Case Study
Justin Hall, Vice President & General
Manager EMEA, NeoTract Inc.
2. Mission:
Identify Clinical Needs
Develop Paradigm Shifts
Invent or License
Prove Feasibility
Launch Medtech Companies
Innovation driven by clinical need
Improve Quality of Care
NeoTract, Inc. initiated within
ExploraMed, a Medical Device
Incubator
3. ExploraMed – results
• 1995 Founded
• 1996 EndoMatrix,Inc.
• Tissue bulking device for incontinence.
• Acquired by C.R. Bard in 1997
• 1996 TransVascular,Inc.
• Percutaneous bypass, stem cell therapy
• Acquired by Medtronic in 2003
• 2004 Acclarent,Inc.
• ENT “Balloon Sinuplasty”
• Acquired by J&J in 2010
• 2005 NeoTract,Inc.
• UroLift BPH implant
• 2006 Vibrynt,Inc.
• Implant for morbid obesity
• 2007 Moximed,Inc.
• KineSpring for knee osteoarthritis
• 2014 Nuelle launched
• Female sexual health
• 2015 NC7 launched
4. NeoTract at a Glance
• Developer of the UroLift® system, a minimally invasive
treatment for Benign Prostatic Hyperplasia (BPH)
• Founded in 2004
• All Manufacturing in Pleasanton: Certified Class 8/100,000 CER
• UroLift approved in USA, Canada, Europe, S Korea,
Singapore, Mexico and Australia
• 15000+ patients treated with UroLift worldwide to
date
150 Employees, Headquartered in Pleasanton, CA
5. Anatomy of BPH secondary to LUTS?
Normal BPH
Hypertrophied
detrusor muscle
Obstructed urinary
flow
PROSTATE
BLADDER
URETHRA
Roehrborn CG, McConnell JD. In: Walsh PC et al, eds. Campbell’s Urology. 8th ed. Philadelphia, Pa: Saunders; 2002:1297-1336.
6. Recognizing the Symptoms of BPH-
A couples disease!
• Frequent urination
• Multiple trips to the bathroom at night
• Sudden urge to urinate
• Difficult or painful urination
• Weak or slow urine flow
• Incomplete elimination of urine
• Stopping and starting of flow
Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012
SO WHAT?
8. BPH: It’s not about the prostate…
• It’s about bladder health.
– Continued obstruction makes bladder
work harder
– Eventually bladder decompensates
– Well documented
– BPH medications affect symptoms but
do not reduce obstruction – bladder
health inevitably worsens
• Men undergo surgery much later in
the disease process
• Bladder remains obstructed, less
opportunity for recovery
1 Flanigan, Reda, Bruskewitz et al. J Urol 1998.
WW: watchful waiting
TURP: transurethral resection of the prostate
DiseaseProgression
10. Recently we set out to map this
cost for NICE and Lord Carter’s
review…....
11. BPH – Annual burden for Primary Care
NeoTract Confidential
£9,047,638.54
£16,421,465.42
£14,480,338.04
£1,687,089.52
£7,166,325.84
£57,667,708.81
£1,770.28
Finasteride
Dutasteride
Alfuzosin Hydrochloride
Indoramin
Tamsulosin & Dutasteride
Hydrochloride
Tamsulosin Hydrochloride
Terazosin Hydrochloride
Annual Spend on BPH drugs1
£107 Million
Primary Care Consultations2
1.6 Million
Cost of Primary Care
Consultations (2003)3
£44 Million
1. Health and Social Care Information Centre 2014. 2. Kirby R et al. ProState of the Nation report. A call to action: delivering more effective care
for BPH patients in the UK. 2009. 3. Speakman M et al. BJU Int 2015; 115:508-519
12. Burden of BPH – Hospital admissions
NeoTract Confidential
Annual burden of BPH (2014/15)
Unique patients: 130,584
Admissions: 184,449
Procedures: 237,341
Cost per year £321 Million
50% non-elective
Average LOS = 9.5 days
5-year burden of BPH (2009 -2014)
Total admissions: 1 Million (trending up)
Cost £1.7 Billion
£2,457
Health Episode Statistics. Patients entering hospital who are diagnosed with BPH (N40X
any diagnosis position). Cost based on national Tariff
13. BPH surgery – Annual cost
NeoTract Confidential
Health Episode Statistics – OPCS M65, 2014/15. Cost based on National Schedule of
References Costs LB25E 2013/14
Procedures: 18,699
Cost per patient £2,718
Cost per year £51 Million
Inpatient bed days 51,000
Elective theatre hours 19,000-29,000
94% Elective vs 6% day case
Average LOS = 2.74 days
60% patients have major or intermediate
complications and co-morbidities
£51 Million
14. 5 year pathway burden of post-operative
complications following BPH surgery
NeoTract Confidential
Source: Health Economic Statistics. For every patient who had BPH surgery (OPCS M65) in 2009, an analysis of complications (listed by
ICD10) for each of the 5 years following the procedure. Numbers of spells and costs (based on tariff) for this activity
15. Cumulative and annual cost burden of
complications from BPH surgery
NeoTract Confidential
£0
£20,000,000
£40,000,000
£60,000,000
£80,000,000
£100,000,000
£120,000,000
2009 2010 2011 2012 2013 2014
Total annual cost of
complications
£109 Million
70,000
hospital spells
Cumulative cost of complications from single cohort of
patients treated in 2009
Source: Health Economic Statistics. For every patient who had BPH surgery (OPCS M65) in 2009, an analysis of complications (listed by
ICD10) for each of the 5 years following the procedure. Numbers of spells and costs (based on tariff) for this activity
16. > 1 in 5 patients return to BPH drug treatment
after surgery
NeoTract Confidential
Strope S et al. Urology 2015; 86: 1115-1122
BPH Medication after TURP or Laser
21%25%
17. Even 1 in 10 de-novo patients require BPH
medication after surgery
NeoTract Confidential
11% 8%
BPH Medication after TURP or Laser
18. The LUTS / BPH Cycle – Burden of Care
NeoTract Confidential
Primary Care
(Medication / GP
Consultations)
Emergency
Admission
Surgery
Post-operative
Complications
19. SOLUTION?: Can we Shift Paradigm of BPH care to Increase
Impact & Lower Cost
Disease Progression
CostofCare
Prevention
Surgery
Prostatic
Urethral Lift
• Earlier disobstruction reverses bladder decay
21. NEED: Nothing Fills the Ideal Space
Tolerability
Effectiveness
•Decreased libido
•Ineffective first 2-3 mo.1,5
•Difficult recovery period
•Catheter 1-2 wks3
•4-6 wks before improvement4
•30-70% irritative symptoms1
•Inconsistent response
1 AUA Guidelines 2003
2 Varkarakis et al, The Prostate 58: 248-251(2004)
3 Rubenstin J, Transurethral Microwave Thermotherapy of the Prostate (TUMT), eMedicine article, July 2004
4 Muruve, N, Transuretheral Needle Ablation of the Prostate (TUNA), eMedicine article, June 2005
5 AUA: Urologyhealth.org
5ari
TUMT
TUNA
•Fatigue, dizziness,
anejaculation, impotence1,5
•Surgical Standard
•5% Re-op at 10 yrs1,2
•3-5 hospital days
•4-6 weeks recovery
•65% ejac dysfunction1
•10% impotence1
•TURP-like with
reduced bleeding
Alpha
Blocker
Laser
TURP
22. The Solution that Urologists & Healthcare
Systems Seek
• Straightforward Procedure
– Rapidly and easily deployable (no capital outlay, infrastructure
or staff changes
– Reliable, reproducible
– Ambulatory - Local anesthesia
• Rapid Relief
– Reduce patient complications, recovery time and healthcare burden
• Preserve Function
– Bladder function
– Sexual function
• Durable
– Years of relief
• Cost Effective
– Less expensive for system
23. A NEW View: What is BPH really?
• BPH is a mechanical problem.
• Benign Prostate Hyperplasia is, by
definition, benign tissue.
• Removing or destroying this benign
tissue can cause complications.
• Why not just move it out of the way?
Pressure
Hyperplastic
tissue takes more
work to open
24.
25. Fast Forward The Award Winning UroLift® Implant
Permanent Transprostatic Implant
2015 BRONZE
26. UroLift Becoming a Standard of Care
11 years of Diligent Development
PUBLISHED
Randomized
Crossover Study
Positive
Guidance
N.I.C.E.PUBLISHED
2 Year
Durability
De Novo
Approval
HCPCS Coding
Coverage
AETNA
PUBLISHED
Randomized
Blinded Study
PUBLISHED
Sexual
Function
Over 8,000
treated
PUBLISHED
3 Year
Randomized
Durability
PUBLISHED
BPH6 Study:
Randomized
to TURP
Coverage
Medicare 49 states
Kaiser, Aetna
Several Blue Cross
Several privates
PUBLISHED
‘Real-World’
European
Registry
PUBLISHED
Safety &
Feasibility
Category 1
CPT Codes
[Effective Jan’15]
PUBLISHED
LOCAL Study
MAC00226-01 Rev A Positive MTEP
N.I.C.E.
27. Clinical evidence – unrivaled in BPH
technologies
Published:
Can J Urol USA Randomized (n=206, 3 yr)
EU J Urol BPH6 Randomized (n=80, 1 yr)
Blad Dys Rep Meta-Analysis
Urology Practice USA Randomized (n=206, 2 yr)
J Urology USA Randomized (n=206, 1 yr)
J Sex Med USA Sexual Function Analysis (n=140, 1 yr)
BJUI USA Crossover Study (n=53, 1 yr)
Can J Urol USA LOCAL Study (n=51, 1 mo)
EU J Urol EU Multi-National Study (n=102, 1 yr)
Urology J. 2 Year Multi-Center Study (n=64, 2 yrs)
J. Sex Med Sexual Function Analysis (n=64)
BJUI First-in-Man Experience (n=19, 1 yr)
Pop Health Health Economics of UroLift
Can J Urol Technique
Prog Urologie French experience
Urol Neur Uro Spanish experience
28. Rapid, reproducible and durable results
0
5
10
15
20
25
0 6 12 18 24 30 36 42 48
MeanIPSS
Months
Roehrborn et al.
Sonksen et al.
McNicholas et al.
Chin et al.
Roehrborn et al. Can J Urol 2015; Sonksen et al. Eur Urol 2015; McNicholas et al. Eur Urol 2013; Chin et al. Urology 2012
MAC00226-01 Rev A
Retreatment remains low: 12.6% at 4 years
4-year data presented at EAU
Congress March 2016 recently
published
29. Minimally Invasive Safety Profile
Most common AE were mild to moderate, typically resolve by 2-4 weeks:
No incidence (0%) of de novo sustained ejaculatory or erectile dysfunction.
PUL
Subjects
Control
Subjects
Dysuria 34% 17%
Hematuria 26% 5%
Pelvic pain 18% 5%
Urgency 7% 0%
Urge Incontinence 4% 2%
UTI 3% 2%
Roehrborn et al. Can J Urol 2015
30. Improved Quality of Care
• UroLift patients recover more quickly
– TURP catches up only between 6 to 12 months
• UroLift patients satisfied sooner and to greater extent
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 3 6 9 12
Recovered(QoRVAS)
Months
PUL
TURP
p<0.05
p<0.05
Sonksen et al. Eur Urol 2015; 68; 643-652.
55%
60%
65%
70%
75%
80%
85%
90%
95%
1 2 3 4 5 6 7 8 9 10 11 12
SatisfiedPatients*
Months
PUL
TURP
*would recommend procedure
PUL randomized to TURP [gold standard surgery]
31. UK N.I.C.E. Approves UroLift as Cost Effective
Alternative to TURP
• Only BPH procedure to be
shown to be cost effective
when compared to TURP
and HoLEP (e.g. Greenlight
laser is not recommended).
32. The Solution that Urologists & Healthcare
Systems Seek
• Straightforward Procedure
– Reliable, reproducible
– Local anesthesia
• Rapid Relief
– Reduce patient “earn out” and practice burden
• Preserve Function
– Bladder function
– Sexual function
• Durable
– Years of relief
• Cost Effective
– Less expensive for system
35. Mapping our Journey into the NHS … and we are
just getting going
CE Mark
NICE IPG
Urolift
given
incorrect
OPCS
code)
NICE
Medical
Technology
Guidance
New
combination
code in
HRG4+
announced
Introduction
of HRG4+
delayed for
1 year
Urolift
included in
Accelerated
Access
Review
Urolift
awarded
Innovation
Technology
Tariff*
(effective 1
April 2017)
*Subject to consultation
Oct 2014
First NHS patients treated
with UroLift as part of pilot
at Frimley Park
Other hospitals adopt Urolift – at risk
due to insufficient funding through
tariff
Start programme of
engagement with
AHSNs
Innovation
EXPO –
showcased
by Wessex
AHSN
Jan 20142010 Aug 2015 Sept 2015 Apr 2016 Oct 2016 Nov 2016
36. Mapping our Journey into the NHS … and we are
just getting going
CE Mark
NICE IPG
Urolift
given
incorrect
OPCS
code)
NICE
Medical
Technology
Guidance
New
combination
code in
HRG4+
announced
Introduction
of HRG4+
delayed for
1 year
Urolift
included in
Accelerated
Access
Review
Urolift
awarded
Innovation
Technology
Tariff*
(effective 1
April 2017)
*Subject to consultation
Oct 2014
First NHS patients treated
with UroLift as part of pilot
at Frimley Park
Start programme of
engagement with
AHSNs
Innovation
EXPO –
showcased
by Wessex
AHSN
Jan 20142010 Aug 2015 Sept 2015 Apr 2016 Oct 2016 Nov 2016
The UroLift system should be considered for use in men with
lower urinary tract symptoms of benign prostatic hyperplasia
who are aged 50 years and older and who have a prostate of
less than 100 cm3.
37. Mapping our Journey into the NHS … and we are
just getting going
CE Mark
NICE IPG
Urolift
given
incorrect
OPCS
code)
NICE
Medical
Technology
Guidance
New
combination
code in
HRG4+
announced
Introduction
of HRG4+
delayed for
1 year
Urolift
included in
Accelerated
Access
Review
Urolift
awarded
Innovation
Technology
Tariff*
(effective 1
April 2017)
*Subject to consultation
Oct 2014
First NHS patients treated
with UroLift as part of pilot
at Frimley Park
Start programme of
engagement with
AHSNs
Innovation
EXPO –
showcased
by Wessex
AHSN
Jan 20142010 Aug 2015 Sept 2015 Apr 2016 Oct 2016 Nov 2016
Innovative medical technologies with cost saving potential
38. Mapping our Journey into the NHS … and we are
just getting going
CE Mark
NICE IPG
Urolift
given
incorrect
OPCS
code)
NICE
Medical
Technology
Guidance
New
combination
code in
HRG4+
announced
Introduction
of HRG4+
delayed for
1 year
Urolift
included in
Accelerated
Access
Review
Urolift
awarded
Innovation
Technology
Tariff*
(effective 1
April 2017)
*Subject to consultation
Oct 2014
First NHS patients treated
with UroLift as part of pilot
at Frimley Park
Start programme of
engagement with
AHSNs
Innovation
EXPO –
showcased
by Wessex
AHSN
Jan 20142010 Aug 2015 Sept 2015 Apr 2016 Oct 2016 Nov 2016
Innovation and Technology tariff will:
• help cut the hassle experienced by clinicians and innovators in getting uptake and
spread across the NHS
• guarantee automatic reimbursement of approved technologies
NHS England, November 2016
39. Mapping our Journey into the NHS … and we are
just getting going
CE Mark
NICE IPG
Urolift
given
incorrect
OPCS
code)
NICE
Medical
Technology
Guidance
New
combination
code in
HRG4+
announced
Introduction
of HRG4+
delayed for
1 year
Urolift
included in
Accelerated
Access
Review
Urolift
awarded
Innovation
Technology
Tariff*
(effective 1
April 2017)
*Subject to consultation
Oct 2014
First NHS patients treated
with UroLift as part of pilot
at Frimley Park
Other hospitals adopt Urolift – at risk
due to insufficient funding through
tariff
Start programme of
engagement with
AHSNs
Innovation
EXPO –
showcased
by Wessex
AHSN
Jan 20142010 Aug 2015 Sept 2015 Apr 2016 Oct 2016 Nov 2016
Innovation and Technology tariff will:
• help cut the hassle experienced by clinicians and innovators in getting uptake and
spread across the NHS
• guarantee automatic reimbursement of approved technologies
NHS England, November 2016
40. Scope of the productivity and efficiency savings
from Urolift
40% Adoption
Clinical practice tells us that >40%
of men undergoing surgery for
LUTS would be clinically eligible
for a prostatic urethral lift
procedure as alternative to
current surgical practice
NeoTract Confidential
Men requiring
surgery for BPH
Urolift
>40%
41. LUTS due to BPH: Impact of UroLift on Pathway*
*Estimate based on 8,000 UroLift/yr (40% of TURP pts)
COSTS BURDEN TO THE NHS
Reduces Primary Care consultations
£ Saving to be determined
PRIMARY CARE
ACUTE CARE
BPH-related hospital
episodes
Surgery
ACUTE CARE
Reduces procedure costs
>£4 Million/yr saving
Saves 21,000 bed days and 8,000-12,000
main theatre hours
BPH drug treatment
£107 Million/yr
Primary Care Consultations
1.6 million consultations
£44 Million/yr
BPH-related hospital episodes
£321 Million/yr
Average length of stay: 9 days
50% of acute care is non-elective
Elective BPH surgery
£54 Million/yr
20,000 TURP procedures/yr
60,000 inpatient bed days/yr
20-40,000 theatre hours/yr
Surgery-related complications
£109 Million/yr
70,000 hospital spells
Reduces complication costs and hospital spells
>£22 Million/yr
Saves 14,000 hospital spells
New drug
use within
3 yrs of
TURP:
22%
Reduces BPH drug treatment
£ Saving to be determined
ESTIMATED COST SAVING