SRP 115 Surgical Intervention for Bladder Outflow Obstruction

Policy Number: SRP 115
Policy Name: Surgical Intervention for Bladder Outflow Obstruction (BOO)
Status: Group Prior Approval
Effective Date: 1 September 2025
Next Review Date: 31 August 2028

Bladder outflow obstructive surgery is a therapeutic procedure to treat men with symptomatic lower urinary tract symptoms (LUTS) due to bladder outflow obstruction (BOO).  The most common cause for BOO is benign prostatic obstruction (BPO), rarer causes include bladder neck stenosis. Patient information can be found here-Shared Decision Support tool.

Mid and South Essex ICB commissions surgery for bladder outflow obstruction (BOO) on a restricted basis, in patients with a diagnosis of BOO* meeting the following criteria as per NICE CG97:

  • The patient has severe voiding symptoms
    OR
  • Conservative management options and drug treatment[1] are inappropriate or have been unsuccessful
    AND
  • The patient participated in a structured shared decision-making process, with comprehensive discussion of available treatment options

* BOO is defined according to the European Association of Urology where the patient cannot void >150mls, the maximum flow is <10mls/s or with a post void residual >300mls.

Where applicable, the referral letter must detail conservative methods tried and the length of time that each of these was carried out.  The surgeon should document in the patient’s clinical notes that treatment options have been discussed with the patient using the Shared Decision Support tool.  This tool provides information on the different surgical options available.

Surgical Modality

As a general principle it is expected that patients are managed and treated in a setting which not only meets their clinical needs but is charged at the lowest appropriate tariff charge.

[1] Further information can be found via the Medicines Optimisation Primary Care Hub

Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.

Individual funding requests should only be made where the patient demonstrates clinical exceptionality.

Further information on applying for funding in exceptional clinical circumstances can be found on the ICBs website.

Rationale

NICE guidance provides clear evidence, in clinical and cost-effectiveness terms, that patients voiding LUTS presumed secondary to BPO, should be offered surgical intervention as part of a stepped approach to management:

  1. Conservative, or lifestyle interventions should be discussed such a bladder training, hydration management and pelvic floor exercises.
  2. Drug therapy should be considered, in the context of more persistent LUTS, or LUTS not responding to simple lifestyle interventions.
  3. Where LUTS persist, or if medical management is not tolerated, intervention should be considered using a shared decision-making approach.

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