Policy Category: cba+pa who usually applies for funding? Consultant

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Policy Category:


Who usually applies for funding?



Microwave or Laser surgery for benign prostatic hyperplasia

Commissioning decision

The CCG will provide funding for Laser surgery for benign prostatic hyperplasia for patients who meet the criteria defined within this policy. Funding approval for eligible patients must be sought from the CCG via the Prior Approval process prior to treatment.

Policy Statement:

Gloucestershire Clinical Commissioning Group will fund Holmium Laser Enucleation of the Prostate (HoLEP) for patients with large prostate (at least 60mls volume). The procedure must be undertaken at a centre specialising in the technique in line with NICE guidance.

Greenlight XPS will be funded if the patient meets the NICE criteria and is suitable for daycase surgery.

All other forms of laser surgery and microwave surgery for benign prostatic hyperplasia are not normally funded.


There are a number of possible laser treatments for benign prostatic hyperplasia, the most common being thulium laser vaporesection of the prostate (ThuVARP) and Holmium Laser Enucleation of the Prostate (HoLEP).
The National Institute for Health and Clinical Excellence have issued guidance in relation to HoLEP indicating that it is at least as effective and safe as a tradition transurethral resection of the prostate (TURP), and may be associated with less blood loss shorter lengths of stay than TURP. The procedure requires special training and should therefore only be undertaken at a centre specialising in the technique in line with NICE guidance.
The value of alternative laser treatments, including ThuVARP, for benign prostatic hyperplasia has not been demonstrated and therefore these treatments are not normally funded (unless part of a pre-agreed trial).

Plain English Summary:

Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), is a condition that affects older men. When the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes). This can affect how you pass urine and may cause:

In some men, the symptoms are mild and don't require treatment. In others, the symptoms can be very troublesome and have a major impact on a person's quality of life.

Treatment options can include lifestyle changes, medication, and surgery. Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication. The most common surgical intervation is called a transrethral resection of the prostate, which involves surgically removing excess tissue from the prostate. A number of newer surgical techniques also exist that involve the use of lasers. The most effective of these procedures is holmium laser enucleation of the prostate, which uses a laser to remove excess tissue. This procedure has been approved by the National Institute for Health and Clinical Excellence. Other laser treatments also exist but there is less evidence to demonstrate their effectiveness.
If your doctor believes that you meet the criteria set out in this policy they can submit a Prior Approval application to the CCG in order to seek funding approval for your surgery. The CCG will review your case and if we agree that the criteria have been met we will authorise funding.

Evidence base:

NICE Interventional Procedure Guidance (IPG17)

Link to application form – Prior Approval application

For further information please contact GLCCG.IFR@nhs.net

Date of publication

4th April 2016 minor amendment 11.7.16

Policy review date

April 2019 (reviewed 16.05.17 – no change)




Planned Care Programme Board

July 2015


May-June 2015

GP Membership (via What’s New This Week)

July-August 2015

Has the consultation included patient representatives?


Policy sign off

Reviewing Body

Date of review

Effective Clinical Commissioning Policy Group

17th September 2015

Integrated Governance and Quality Committee

3rd March 2016

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