Lesinurad for treating chronic hyperuricaemia in people with gout [TA506]

New: Technology appraisal guidance


Lesinurad is not recommended within its marketing authorisation, that is, with a xanthine oxidase inhibitor for treating hyperuricaemia in adults with gout whose serum uric acid is above the target level despite an adequate dose of a xanthine oxidase inhibitor alone.


This recommendation is not intended to affect treatment with lesinurad that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Memokath-051 stent for ureteric obstruction [MTG 35]

New: Medical technologies guidance


The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.


The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.

Atezolizumab for untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable [TA492]

New technology appraisal guidance from NICE:

Atezolizumab is recommended for use within the Cancer Drugs Fund as an option for untreated locally advanced or metastatic urothelial carcinoma in adults, for whom cisplatin-based chemotherapy is unsuitable, only if the conditions of the managed access agreement for atezolizumab are followed.

This recommendation is not intended to affect treatment with atezolizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Antimicrobial prescribing: Ceftazidime/avibactam [ES16]

New: Evidence Summary from NICE:

This evidence summary outlines the best available evidence for a new intravenous antimicrobial, ceftazidime/avibactam (Zavicefta). It is indicated for treating:

Ceftazidime/avibactam is indicated for treating complicated intra-abdominal infections, complicated urinary tract infections, including pyelonephritis, hospital‑acquired pneumonia, including ventilator‑associated pneumonia, and infections due to aerobic gram‑negative organisms in adults with limited treatment options.

For full information see the summary of product characteristic (SPC): ceftazidime/avibactam.

Durvalumab (Imfinzi) for locally advanced or metastatic urothelial bladder cancer – first line

Durvalumab is an antibody drug that is being developed as an intravenous infusion for the treatment of locally advanced or metastatic UBC. The drug acts in a unique way to stimulate the body’s natural defences that fight the cancer cells. This has the potential to increase survival rates and reduce side effects when compared to current treatment options.

From the NIHR Innovation Observatory

NIHR Signal Placing wet gauze on babies’ tummies speeds up urine collection

Almost a third of infants managed to urinate within five minutes after a painless, cheap technique that stimulates the skin, compared with 12% of infants observed only, as is standard practice.

The ‘Quick-Wee’ method involved rubbing the babies’ abdomens gently with gauze soaked in cold saline before collecting urine. This trial was carried out with 354 babies aged one to 11 months in one Australian paediatrics emergency room.

NICE guidelines recommend non-invasive ‘clean catch’ collection if possible but this can be difficult, especially in young children. They estimate that 20 minutes of staff time can be needed to obtain a sample. Hospital paediatrics settings and primary care may want to try this promising, cheap and safe technique.

There was no difference in rates of contamination and it may reduce the number of babies who need to go on to the less desirable collection by pad samples or invasive techniques.

From the NIHR Dissemination Centre

English Surveillance Programme for Antimicrobial Utilisation and Resistance’ (ESPAUR)

The 'English Surveillance Programme for Antimicrobial Utilisation and Resistance’ (ESPAUR) report says more than one million UTI samples were analysed in NHS laboratories across England last year (2016), and that resistance was a “common” observation.

One in three (34%) of the samples analysed were found to be resistant to an antibiotic called trimethoprim, compared to 29.1% in 2015.

Public Health England has also launched a major new campaign to help ‘Keep Antibiotics Working’.

The campaign warns people that taking antibiotics when they are not needed puts them at risk of a more severe or longer infection, and urges people to take their doctor’s advice on antibiotics.

Urinary tract infection in under 16s: diagnosis and management [CG54] / QS36

Updated. Guidanca from NICE. It covers diagnosing and managing first or recurrent upper or lower urinary tract infections in infants, children and young people. It aims to achieve more consistent clinical practice, based on accurate diagnosis and effective management.

This guideline includes recommendations on:

• investigations and diagnosis
• acute management
• imaging tests
• surgical intervention
• follow-up
• information and advice for children, young people and parents or carers

See also Urinary tract infection in children and young people quality standard.

Memokath-028, 044 and 045 stents for urethral obstruction [MIB123]

New NICE Advice Medtech innovation briefing

Memokath-028, 044 and 045 stents for urethral obstruction

The technologies described in this briefing are the Memokath‑028, Memokath‑044 and Memokath‑045 stents. They are used to relieve urethral obstructions and bladder neck or outlet obstructions.

The innovative aspects are that the stents are designed to be easily inserted and removed compared with other urethral stents or indwelling catheters.

Mesh Oversight Group Report on vaginal mesh implant

This Mesh Oversight Group Report follows on from the Mesh Working Group Interim Report of December 2015. Both reports are about vaginal mesh implants used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women.

See RCOG's and BSUG's joint response to the report.

Catheter-free nephrectomy: A safe change to routine practice

Journal of Clinical Urology.  First Published May 26, 2017 

The aim of this article is to assess any difference in length of stay (LOS), complications and readmission rates between patients who had catheter-free nephrectomy compared to those who had a catheter inserted as routine peri-operatively.

UHCW Research: E. F. Zimmermann.

Reducing Catheter Associated Urinary Tract Infections (CAUTI’s) at a District General Hospital Can change be sustained?

This shared-learning tool describes how Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.

A clinical audit to assess the compliance of documentation of the urinary catheter care bundle in the inpatient units of Berkshire Healthcare NHS Foundation Trust

From the NICE shared learning database

A clinical audit was undertaken covering the Trust’s inpatient units in order to assess the compliance of staff in the use of documentation for a catheter care bundle for patients with an indwelling catheter in line with the NICE clinical guideline for Healthcare-associated infections: prevention and control in primary and community care (CG139) and the NICE Quality Standard 61 for Infection control and prevention.

Geographic patterns of cancer survival, England: 2015

Survival at 1 year and 5 years after diagnosis improved for the 8 cancers examined in this report (colon, breast, cervix,prostate, oesophagus, stomach, bladder, lung) among adults diagnosed in England between 2003 and 2010. Differences in net survival between the 4 NHS Regions are generally small, of the order 1% to 3%. Survival improved slightly but consistently in all 4 regions for 7 of the 8 cancers.

Extraurethral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women

New NICE Interventional Procedures Guidance on extraurethral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women. This involves putting 2 small balloons on either side of the tube that carries urine from the bladder to support it and reduce leaks.

Understanding NHS financial pressures: how are they affecting patient care?

This King's Fund report examines the impact of NHS financial pressures on patient care across four different parts of the health system: genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal services.

Latest Pharmacological Technology Briefings - March 2017

NIHR Horizon Scanning Research and Intelligence Centre's latest batch of briefings on pharmacological technologies in development is now available:

• SQ HDM SLIT-tablet for house dust mite allergic asthma
• Pembrolizumab (Keytruda) for locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy – first line
• Pembrolizumab (Keytruda) for endometrial carcinoma – second line
• Ipilimumab (Yervoy) for unresectable malignant melanoma in paediatric patients
•  Inotersen (Ionis TTRRx) for hereditary transthyretin amyloidosis with polyneuropathy (hATTR-PN) – first line
• Galcanezumab for prevention of chronic cluster headache 
• Dupilumab for persistent asthma – add on therapy 
• DNX-2401 for recurrent glioblastoma – in combination with pembrolizumab 
• Cefiderocol for severe gram-negative infections 
• Cannabidiol (Epidiolex) for Dravet syndrome – second and subsequent line 
• Cabozantinib (Cabometyx) for advanced or metastatic renal cell carcinoma – first line 
• Atezolizumab (Tecentriq) with gemcitabine and carboplatin for advanced bladder cancer 
• Atezolizumab (Tecentriq) in combination with carboplatin and paclitaxel, alone or in combination with bevacizumab, in patients with metastatic non-squamous non-small cell lung cancer – first line 
• ATA129 for Epstein-Barr virus-associated post-transplant lymphoproliferative disorder

Tadalafil Medical Expulsive Therapy in Ureteral Calculi: A New Kid on the Block?

New from BestBETs:

In [adult patients presenting to the Emergency Department with distal ureteral calculi] how does [tadalafil compared to alpha receptor blockers] increase the [time and success of spontaneous stone passage]?

The available literature suggests that tadalafil is neither more efficacious nor safer than tamsulosin. Combined therapy with tamsulosin and tadalafil may increase stone passage rate and decrease expulsion time relative to tamsulosin alone, however larger studies are needed to establish efficacy and safety of combination therapy.

Radical treatment for bladder cancer

The radical treatment for bladder cancer section of the Royal College of Radiologists' guidance on Radiotherapy Dose Fractionation (2nd ed.) has been corrected

U-Drain for people needing night drainage of urine or dialysis fluid

NICE has developed a medtech innovation briefing (MIB) on U-Drain for people needing night drainage of urine or dialysis fluid.