Temporary implantable nitinol device (iTIND)

This information leaflet is for male patients with bothersome urinary symptoms who are considering surgery.

We have written this leaflet to tell you about iTIND®, which is a minimally invasive treatment for bothersome urinary symptoms in men who have a blockage to urine leaving the bladder; a blockage that needs surgery to correct. We will discuss other suitable prostate treatment options with you as well, including:

• transurethral resection of your prostate gland (TURP)
• laser resection of the prostate (HoLEP)
• urolift prostatic implants
• steam resection of the prostate (Rezum)

Your surgical team will discuss these options with you to agree the best option for you, weighing up the risks and benefits of each procedure. There is a short explanation of each of these options in the section below entitled 'Are there alternative treatments?'

The benefits of iTIND® over conventional surgery include the following:

• a shorter hospital stay
• most men do not need a catheter around the time of the procedure
• the risk of bleeding both during/after the operation is very small, and the need for a blood transfusion is very rare
• there is a rapid recovery with no change in your continence or sexual function

Why do I need this?

The prostate is a small gland located right below the neck of the bladder. It is part of the male reproductive system. As men age, the prostate often becomes enlarged. This causes it to press against the urethra, causing chronic and sometimes troublesome lower urinary tract complaints, such as poor flow and a need to pass urine often.

Are there alternative treatments?

The doctor treating you will be able to discuss how to reach the right decision as to the most appropriate treatment for you. These include:

• Conservative treatment: restricting your fluid or caffeine intake to improve your urinary symptoms may help avoid surgery.
• Drug treatment: using either finasteride (to shrink the prostate) or drugs which relax the muscles in the prostate (eg tamsulosin) to improve urine flow.
• Transurethral resection of the prostate (TURP): removing the central obstructing part of the prostate with an electric current, using a telescope passed along the urethra.
• Laser enucleation of the prostate: removing all the obstructing prostate tissue with a laser, using a telescope passed along the urethra.

About the iTIND procedure

What can I expect during the procedure?

The iTIND treatment is a simple procedure performed by a urologist, either in a hospital or clinic.

The device is placed in the waterpipe which travels through the prostate gland (prostatic urethra). During the five to seven day treatment, it slowly expands and gently reshapes the urethra. This widens the opening through which urine flows which leads to better urine flow and a reduced need to pass urine so often.

After five to seven days, an automatic second appointment is arranged for the device to be removed under local anaesthetic in either a theatre or clinic room.

What happens before the procedure?

You will receive an appointment for a pre-assessment to assess your general fitness and to screen for possible infections such as MRSA/COVID-19 and to do some tests.

What happens on the day of the procedure?

As this is usually a planned (elective) operation. You will arrive at the hospital on the same day as your procedure. Once you have been admitted, you will be seen by the urologist or a team member who will be performing the procedure and asked to sign an operation consent form giving permission for your procedure to take place. This shows that you understand what is to be done, and confirms that you want to go ahead. Please feel free to discuss any concerns and ask any questions before giving your consent.

The iTIND® implant will be inserted for you in either in an operating room or in a clinic room. The procedure will be carried out under a general anaesthetic, local anaesthetic or short-acting sedation according to your circumstances. Your surgeon will decide this with you and discuss it in detail.

You will usually be given some antibiotics before the procedure, after we have checked for any allergies you may have.

What does the procedure involve?

A small cystoscope (camera) will be placed through your urethra (waterpipe) and into your bladder. Using the camera, the iTIND® device is opened in the part of the urethra that passes through the prostate (the prostatic urethra). The iTIND® then slowly expands to widen the channel to pass urine. The aim is to permanently improve urine flow and emptying of the bladder once the device is removed.

The iTIND® device is left in position for five to seven days. A thread runs from the device out of your penis, to which it is taped. Please do not cut or damage the thread, as it will be used to remove the device.

During this five- to seven-day period, avoid:

• sexual intercourse
• strenuous activities

Removal of the iTIND

You will be asked to return to the hospital five to seven days later to have the iTIND® device removed under local anesthetic using an open-ended tube (catheter).

We would expect some improvement in urinary symptoms after the device has been removed. Symptoms can continue to improve over the next six to 12 weeks.

You will typically go home shortly after the procedures once you have passed urine. You should arrange for someone to drive or accompany you home.

You may return to normal activities one or two days after the device is removed.

Possible problems you may encounter

• Temporary blood in the urine. (12%).
• Mild to moderate discomfort whilst the device is in place in the body. This can be treated with painkillers and steroid tablets temporarily whilst needed. (10%)
• Urine infection needing antibiotic treatment. (6%)
• Temporary burning or stinging passing urine.
• Irritable urinary symptoms whilst the device is in place (pressure around the area of the perineum and increased urgency and frequency to urinate). (11%)
• Once removed – failure to completely or significantly improve your urinary symptoms needing additional or alternative treatments.
• Inability to pass urine, requiring insertion of a catheter (drainage tube) to drain urine from the bladder. (4%)
• Risk of anaesthetic.

This operation has not been associated with adverse effects on erections, ejaculation or leaking of urine.

MyChart

We would encourage you to sign up for MyChart (opens in a new tab). This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

More information about MyChart is available on our website.

Contacts/Further information

Clinic 4A Urology Clinic: 01223 274608
Clinical specialist nurses: 01223 586593 or via MyChart

References/Sources of evidence

iAluril website (opens in a new tab): Self-administration videos

Hyacyst (opens in a new tab):

• A guide to self-instillation of Hyacyst for women
• A guide to self-instillation of Hyacyst for men

British Association of Urological Surgeons (BAUS (opens in a new tab))