One-stop clinic for outpatients in Bolton is improving the pathway for men with lower urinal tract symptoms

An aerial view of Bolton.

The one-stop male LUTS clinic at Bolton NHS Foundation Trust is improving the patient pathway for men with lower urinary tract symptoms (LUTS) whilst using the UroLift System to move procedures away from theatres and develop an improved, entirely outpatient, pathway.

Mr Neil Harvey, a Consultant Urologist at Bolton NHS Foundation Trust has led the way in recognising that males with LUTS experience challenges as part of their treatment, including multiple hospital visits prior to being listed for surgical intervention.

The lower urinary tract includes the bladder and the tube that urine passes through as it leaves the body (urethra). LUTS are common as people get older and can include an urgent or frequent need to pass urine, problems passing urine, and problems after passing urine, such as feeling the need to go again.

The aim of this one-stop clinic was to improve the efficiency of the patient pathway, with the shortest possible referral of treatment and minimising the number of times a patient would need to visit a clinic. By achieving a reduction in hospital visits, this would free-up outpatient appointments for other patients and delivering procedures for patients with enlarged prostates in the outpatient setting enables them to be treated more quickly and without needing to stay in hospital overnight, resulting in an increased theatre capacity and more hospital beds for other patients that need them.

This was delivered via the implementation of two innovative clinical sessions:

  • One-Stop Male LUTS clinic running on Thursday afternoons
  • Local Anaesthetic (LA) outpatient procedure list running on Thursday mornings. The list operates in a procedure room that is typically used for other LA procedures, such as flexible cystoscopy and trans-perineal prostate biopsy

Mr Neil Harvey, Consultant Urologist at Bolton NHS Foundation Trust, said: “Now we see patients come away with a plan from the first appointment. Previously, patients would wait for six-months to even get a plan to treat their symptoms, and then they still have a year-long wait for surgery after that. So, we saw the alternative and implemented it, instead of patients waiting for that long and understandably becoming frustrated.

“Now, I see patients come back from the UroLift System procedure and say their experience has been very positive, while I know their journey has been far shorter than it could have been.

“I think the numbers speak for themselves, as we have dramatically reduced the number of patients coming back for unnecessary follow-up appointments, and we have similarly increased the number of patients that are being listed straight for surgery from their first attendance at hospital.

“Because this is a dedicated clinic, we know that we are much better at gathering the information that is required, based on guidelines, for the assessment of these patients prior to making a treatment decision. Also, in the appropriate patient, because of an ambulatory pathway, we are able to offer them surgical treatment within the space of weeks rather than the current wait, which for this patient group, is in the region of 78-weeks, which is fairly common up and down the region.”

The UroLift System is a Benign Prostate Hyperplasia technology, supported by the MedTech Funding Mandate (MTFM) for 2022/23, which is delivered in collaboration with the Accelerated Access Collaborative (AAC) and the AHSN Network.

UroLift relieves the symptoms of an enlarged prostate by using small, permanent implants to stop the gland blocking the flow of urine. It’s minimally invasive, improves quality of life, and maintains all sexual function. When patients go home the same day, it’s estimated to save the NHS between £981 and £1,230 over five years for each person treated.

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