Aquablation for BPH

Felix,

You will just have to give this time to heal. Any procedure that cuts into or heats the prostate tissue results in post operative discomfort and requires a period of healing. Also, each patient has a different response to treatment depending on many factors, including size and shape of the prostate and how much tissue was ablated. 

Two and a half months ago I had a PAE procedure, and there was some discomfort for two weeks after due to tissue swelling. Improvement in urinary flow has been slow, but I was able to discontinue my Flomax after 5 weeks. Doctor says it takes about 6 months for the procedure to complete its work. 

I am guessing that you will continue to improve moving forward. 

My best to you,

Tom

Grant, Tom & Felix.  It seams like it's a 50/50 shoot on retro.  To me that's not good odds if your looking for a procedure that will not give it to you.  Some men may be able to deal with that but I think they need to work on it.  Aquablation is just a newer way of doing a TURP.  I do agree it's better then a Turp but it still the same.  Hope all of you heal fast and get results you can live with  Ken 

Thank you for the information.  But it all depends on the side effects.  Ken

Insurance for a new procedure is always a problem. Good luck.

It will be billed as a 52601 (TURP) while the new code is being reviewed.

The good news is the patient won't be responsible for any denials, so it will be very affordable for anyone with insurance.

Do you know if they have the information on the internet.  Do you have a link so we can get more information.   That code is misleading.  If it is not a Turp why bill it as one  Ken

Very often new procedures are excluded in medical malpractice policies as experimental. As a result many practitioners stay away from them.

It has now been FDA approved, so it is no longer experimental.

You are correct, however, as there will only be several centers of excellence which perform this procedure the first year or so.

You probably know that the insurance industry makes their own rules regardless of FDA approval.

Absolutely; the first few years of a new procedure always have hazy rules; however,  most doctors won't charge you if a code is denied, but you should always check when you schedule.

 

Jersey.  I have been reading many of the trail and can't find anything about a % of retro.  They kind of talk about it but don't talk about it.  Urology Times All I could read was No cases of incontinence or erectile dysfunction.  Med Page Today Said that The Aquablation  preserve ejaculatory function and continence to a greater degree.  What is that mean.  I guess there giving you a 50-50 shot.  You have to gamble with your life.  I know they are trying to help you with peeing better but what about the rest of your life. Enjoying sex is part of your life to.    And please don't say all will be the same because it's not for everyone.  Our ejaculation is important still to many of u.  Still going to read up on the internet and If I have to I will e-mail the company.  Have a good day  Ken   

The very early preliminary studies showed no cases of retrograde ejaculation.

I am certain there will be plenty of patients who will have this once larger studies are published, and it will certainly be one of the risks we discuss with patients before they consent for the procedure.

I know I have just read a few men on here that they had the Aquablation and they are peeing ok but ended up with retro which there not happy with.  I think with any procedure that is done it will depend on how good the doctor is and the mapping of the procedure.  Like I said It going to be a gamble and do you feel lucky.  Thank you  Ken

I don't believe physician skill will have much to do with it. As I tell all my patients, there is a risk of retrograde ejaculation with every procedure and medication. Urolift has a very low risk, but I will never quote 0.

I had a urologist recently state to me that performs Urolift that it has a chance of retrograde ejaculation when one gets too close to the bladder neck.  

That is why you make sure you have a good doctor.  That is the only way you get retro from Urolift The doctors mistake.  My doctor told me that 3 years ago. He has done over 200 in 3 years no retro in any of them    Ken  

I know with the Aquablation it will be the mapping and the tissue being removed.  I assumed they will show you the mapping before they do it. And if your not happy you should be able to a just it.  At least your honest.  With all the Urolift being done. They have to keep the bar away from the bladder neck.  So the doctor has to be care full.  So it is up to the doctor.  So you better not p**s him off before surgery   Thank you Ken

Hi Ken- According to the video on the Aquabeam website the risk of retro is 6.9% with the Aquablation over many hundreds [thousands?] of procedures in the USA, New Zealand, and Australia. Whether this stat has been 'doctored' as some claim, there is no way to know.  Much worse than retro are incontinence and ED. If one has an undesirable outcome due to retro, well, that's a shame, but incontinence and ED are both much worse. If an older guy has retro [which for me would be terrible as well] at least he can still express himself sexually, maybe looking at sex as a 'journey of love expression,' instead of goal focused. Cheers- J

Hi Ken... the Aquablation, technically, is a TURP [Trans-Urethral Resection of the Prostate]... as it removes tissue, just in a different way, it uses water jets with no heat. Heat can be a source of nerve damage... This is a potential problem with the laser type of TURP.

Cheers- J

@Jay: Whether this stat has been 'doctored' as some claim, there is no way to know. 

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I'm unaware of anyone here who has said the Aquablation stats have been "doctored", but I did call them into question because the overall retro stats (including TURP) were much lower than reported elsewhere. I theorized -- and that's all -- that there may have been something wrong with the follow-up questionaires, either in how they were worded or administered. For example, there could have been confusing wording or they may have been sent out prior to folks giving their sperm a "test run"   Based on a 30% chance of retro versus TURP, per the study if I remember, then I would put the chance of retro with aquablation closer to 20% and not the 6.9%. Also, keep in mind that these are study stats with more controlled variables than in the real world. I believe for example that the study stats for retro in Rezum seem much lower than what we see here.

Jim

To put it another way, if you give credibility to the 6.9% stat of retro with Rezum, then you would have to give credibility to their stated 21% (by memory) stat on retro with TURP. I can't find any literature, anywhere, with a retro figure that low with TURP.

Jim

Correct; theoretically should be less damage and fewer side effects than other energy sources, such as traditional TURPS, laser TURPs, or even less conventional procedures like the "FLA procedure" 

We just had a single reported instance here of an erectile issue post FLA. As stated, the head of the penis seemed numbed post FLA with erectile problems following that fortunately were resolved with Viagra. I know it's just speculation what might have caused the numbing, but could it be from nerve damage caused by the heat generated by FLA as you seem to suggest (in theory) as opposed to the actual cutting?

Jim

Good evening Jay.  I feel that the Aquablation is much better then a Turp but I think it would be how close to the ducts and all the other good stuff and tissue they get ride of.    And I know the main thing is to pee better.  But on the other hand when she we have to give up anything just to pee better just because we are getting old.  She we will be put out to pasture like a horse.  Doctors not all but some do not consider the ejaculation a sexual function that is way in the UK there messing around with the Urolift saying that if they clip the bladder neck or do a leaser on the bladder neck that it makes it better.  All that does is change the procedure and give you side effect and a longer healing time.  I don't give full control to my doctors when I have to have any surgery.  I read the papers first and if there is something that we did not talk about I do not sign.  I do not want to wake up with any surprises.  We all pick the procedures we are happy with.  And if your happy with the side effect that is your problem and you have to deal with them  Have a great day.  PS  If you read any of the trail on the water jet.  There is nothing saying any % of retro.  They over look it.  And don't talk about retro at all...Ken 

The she is SHOULD  Sorry was going to fast 

Hi Ken- I know, I don't want to give up anything either, that's why I had the FLA first. I'm not eligible for the Urolift either becaude of the median lobe problem. So, unfortunately my options are limited. 

     There are statistics listed in the video on the Aquabeam website, I have screenshots of them. I also have the link for the video on the Aquabeam website. Unfortunately, I cannot give you the link here as the forum 'overseers' may not allow them, and I also cannot  attach my jpg screenshots in a comment either. I'll send them to you in a personal message... 

     Cheers- J

Hey Ken.... Looks like I cannot send you a personal message with any attachments. So, have a look at the video I will send you a link for thru personal messaging. Cheers- J

I'll try sending you the link here. Let's see if it gets posted... Cheers- j

http://www.aua2017.org/webcasts/webcast_play.cfm?videoID=5437&agendaid=14220&id=14213,14214,14220,14222,14223,14231,14232,14233,14237,14057,14076,14262,14263,14264,14265,14266,14267,14268,14269,14270

Hey Jay..  Thank you Just watched it.  I read something like that this morning.  They still don't give a % on retro.  I got that it's better then Turp.  Like I said.  At lease there trying  Ken

Thank you Ken , I agree with you 100%.

No problem New.  We will have to see and time will tell  Take care  Ken

Hey Ken, I agree with you concerns 100%. I am considering prostate artery embolization done only by and interventional radiologist instead of a urologist. The doctor who has done the most in the US is Dr. Bagla in Virginia. He has done close to 500 PAEs.. I am considering Dr. Arron Fischman at Mt Sinai in NYC. He has done about 50 procedures and seems very knowledgeable about the proper way to do the procedure.

But everyone of these procedures has drawbacks. I am on a plant based whole food diet and there is some evidence with time that BPH can be reversed, chance of prostate cancer can be reduced, It is a commitment in terms of time but I feel much healthier on the diet. That of course is subjective. What I think I will do is this. IF there is a procedure that has near 100% chance of not cause, ED, retro ejaculation or incontinence and that lasts for many years and the doctor accepts medicare assignment sign me up! Other wise I will just continue my plant based diet (no meat, dairy eggs or added oil...believe it or not I like the food a lot more this way) and see if eventually my bph sumptoms and some overactive bladder symptoms are reduced. MY prostate is 40g and my prostate medium lob is pushing up into my bladder somewhat.

 I am not being critical to anyone out there. If your BPH symptoms are unbearable one has to take immediate action. My main problem is urinary urgency. Sometimes I have to pull my car over to the side of the road to pee. I hate waking up 3 or 4 times a night to pee but at other times it is more tolerable. Besides the plant based diet there is some evidence that ground flax seed (it is cheap) reduces BPH as well as alpha blockers or alpha reductase inhibitors.

Guys I don't want to appear preachy. I want to get rid of this problem as much as all of you. I am 65 years old. I am not ready to give up my sex life. 

Good luck to all of you!

Sorry your still having a problem but I am glad you have a handle on it.  Me to I'm 62  why should I have to give up anything.  Have you tried Myrbetrig to help relax the bladder.  I try to stay away from anything that can irritate the bladder.  My urologist gave be a 8 page list to try.  It does help but strange things happen and they do not know why.  About a month ago my bladder just stopped.  He does not know why.  He said it was a odd thing don't know what why but he said it may happen again.  I would like to know but that is life.  But I am not going forward on anything that is not 100%.  Take care and have a great holiday Ken   

Hi Ken- this is why I wish this website allowed attachments with comments. I have screenshots of all of the charts/graphs shown in the video.  According to the video, 6.9% ended up with retro, a Clevien-Dindo 1 problem... Cheers

I think that is higher then that.  Even at 6.9 % that is to high if you have a concern with loosing it  Ken

Hello JerseyUrology,

FDA approved aquablation in dec 2017. Do u by any chance know which offices or institutions in NJ (or states near NJ) offer aquablation? 

BCBS covers aquablation and the CPT code is

"0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed) describes waterjet ablation of the prostate with ultrasound guidance."

Thank u.

Jersey Urology group offers it.

I do not know of others

Is Medicare paying for it ? Thanks. Hank

Will call them. Thank u and I sincerely appreciate for giving me the info. 

the CPT code for aquablation is 0421T as mentioned in my post. Don't know about Medicare. For BCBS, I called the insurance directly and also made  sure that there was no "medical necessity requirements" which I had to satisfy ( for example, I had to be on medications for at least 6 months, etc). I would then ask if the jersey urology group is in network I.e.accept my plan.

there will be three charges: the doctor, the hospital  (or facility) and the anesthesialogist. U need to check on all three to see if each cover by ur insurance else u will have to pay for it.

JerseyUrologist may not be able to do all these checkings a for u.

Thanks. Hank

It was pointed out by Lingeman, aquablation was just like TURP's resection, there would be blood in the resected cavity. In TURP, heat is used to cauterize the bleeders. But I don't understand how a balloon work.  If u have time to explain how a catheter with balloon can stop the flow of blood after aquablation, I would sincerely aprecqite it.

A reply from Peter GIlling to Lingeman:

"The commentator (Lingeman) correctly points out the main uncertainties involved with this new treatment from a clinical perspective. Importantly, he reminds us that hemostasis remains an issue following creation of the prostatic cavity by aquablation. The technique of hemostasis used in the current global, phase III study (known as the WATER Study), which has just completed enrollment, now involves catheter traction for 2 hours following surgery with the balloon of the Foley catheter inflated to 50% of the original prostate volume and positioned in the fossa under TRUS guidance.1 This has largely obviated the need for any heat energy needing to be applied to the fossa and is well tolerated by patients. In addition to a further decrease in operating time, it appears that the early irritative voiding symptoms seen with thermal therapies are also less."

There is also one in Jacksonville Fl   Ken

New just saw this post.  Have not been getting a few of them.  The only procedure that is close to a 100 % is UROLIFT.  There is no cutting of the prostate and it will open you up.  There was just a 5 year study that all patients are doing well and they did not have any re-done.  I have talked with one of the inventors of UROLIFT and he said that they are trying for 5 to 7 years.  I'm at 3 1/2 now if I have to have a couple more put in that would be no problem.  Other guys have had 2 3 or 4 surgery in 10 years.  I know the prostate can grown but how much can you cut out.  That would be he-- to go through every 3 or 4 years.  The body can not take that much trauma.  Take care and enjoy your life   Ken

Good even Jay.  It is much higher chance for retro then they want to tell you.  In some of the trails they don't even mention it.  I know there is more to life then sex but there is more to life then peeing and not being able to do anything.  It's not so much has a goal but why should we have to give up anything just to pee better.  That is part of our life to.  Aquablation seam like it would be better that a regular Turp because it is map out.  But I also think it will be the skill of the doctor that is doing it. Turp was the only thing we had many years ago and there are doctor still in the passed But if it was so good they would not have come up with many new ways of helping men.  I was told by Ted ( Inventor ) that the Urolift was invented to help men keep there sexual function's not function.  Most of the time doctor do not consider a man ejaculation a sexual function.  They tell you that your not having anymore kids so you don't need it.  Who are they to tell you what we need.  I know the orgasm and the ejaculation are 2 different things but for me they are one in the same.  I have had a dry orgasm and they suck.  I will not live like that for the rest of my life.  That is why I got off the pill and had a Urolift.  And I would do it again.  Every man has the right to have what ever procedure that he feel will help him.  I just hope men do there research and not let there symptoms or there insurance pick there  procedure.  Well that is enough on that.  Good night all  Ken 

The balloon is inflated inside the prostate and puts pressure on the 'wound'... this is how it helps to minimize the bleeding. Cheers

I read that in one of the trails that was in Phase 2.  They are using it as like a Tourniguet but I wonder with the pressure that they use is it doing some kind of damage to what is left that can ca't see.  No one knows  Ken