Posted , 38 users are following.
Very promising new treatment for BPH now in clinical trials (Water Study):
PROCEPT’s AquaBeam combines image guidance and robotics to deliver Aquablation, a waterjet ablation therapy that enables targeted, controlled, and heat-free removal of tissue for the treatment of lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH).
2 likes, 366 replies
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jay111 tom86211
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You're right Ken... any risk is too much. But according to the video, the risk of retro sits at 6.9%, the way that I interpret the words being used. Whether this will be true in the long term, post trials, time will tell.
I had the FLA surgery, and it failed for me. It IS unfortunate that I am not qualified for the Urolift due to the large median lobe that I have. If I were to CIC all day, every time, I would have to do so prob'ly 15 times a day with my smaller size bladder. So, this is not a long term solution that works for me either. I would be cathetering constantly.
I am glad that the Urolift worked for you, as it also does not work for everyone. I am therefore trapped with a choice... I MUST choose some sort of surgery at some near future point, and all I can do is hope for a good result if I have the Aqua.
I tried to avoid the side effect problem with the FLA, and with travel from Australia, food and lodging, it cost me just over $30,000 AUD. I got nothing but more problems with the FLA. I realize that I am in the minority with this outcome in the FLA patient dot info - Dr. K world.
I have to choose SOMETHING to be done, as I cannot live the way that I am living now. I hope the Aqua works for me as that seems to be the best option now, with the fewest potential side effects compared to other types of TURP procedures. We all have our own h#ll to deal with, unfortunately. There's always euthanasia as an option, I hear.
Cheers- J
kenneth1955 jay111
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dl0808 tom86211
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I am interested in aquablation for reason given below. I hope that more people can post and share their experience here.
My current situation is: I need surgical intervention, and there are TURP, HoLEP, Green Laser, Urolift, Rezum, PAE, Etc. BCBS rejected my preauthorization for Urolift, also I opt for a more durable, more reliable solution. So I eliminated Urolift, PAE, Rezum. I am left with TURP, GLL and HoLEP. I could not convince any GLL urologist to use ejaculation preservation (spare those tissues which is within 1 cm of the verumontanum). So I thought if I am going to get RE, may as well pick the best technology, HoLEP.
I then start reading the posts in "Experiences With Holmium Laser Enucleation Of The Prostate, HoLEP, Laser Surgery" in steadyhealth. This thread has more than a thousand posts!
I was shocked to find out incontinence and to a lesser degree hemasuria are two big problems for HeLEP recipients. Some have incontinence for as long as 7 months and are still suffering from it. Scientific studies do not show how miserable life could be after HoLEP.
Then I remembered aquablation which I rejected before because there was no long term data to show durability, but I realized that it has been five years since it was first used to treat patients and is backed by two well known, well regarded Urologists, Peter GIlling and Roehrborn. Data from Scientific studies showed that aquablation and TURP have about the same functional outcomes, but aqua does not make me incontinence and there is an 89-90% chance I will have normal ejaculation, this really make me hesitate to go for HoLEP right away.
If aquablation is indeed has less complications than HoLEP, then my new situation is: HoLEP is only slightly better than aquablation in functional outcomes (for example HoLEP has the highest Qmax, etc), but aquablation will not have incontinence and there is a 80-90% chance of having normal ejaculation. Aquablation seems to have an edge over HoLEP unless there are complications and disadvantages I don't yet know.
I agree with Ken that a normal ejaculation comes with life and it is something one does not want to give up easily unless one has to regardless of age.
I believe in the 10-20% RE rate for aquablation. The technique of Ejaculation Preservation was derived from a scientific experiment. A group of men were asked to masturbate with a 3D recto ultrasound recorder in place. The tissues responsible for normal ejaculation were identified. These were the tissues within 1 cm of the verumontanum where the two ejaculation ducts are situated. The technique that spares these tissues is known as Ejaculation Preservation Technique. Using this technique, a study showed that Green Light Laser was able to achieve 10-20% RE, which is the same rate quoted by aquablation. If aquablation could be programmed to spare the same tissues as in EP-GLL, then it makes a lot of sense.
Thus, HoLEP has slightly better Qmax, slightly more material removed, but many months of incontinence and 80-90% chance of RE whereas Aquablation has slightly (not by much) lower Qmax, slightly less material removed (not by much), but absent of incontinence and only 10-20% of RE. Which one is better? It will be a personal choice, but I feel that aquablation seems to have an edge over HoLEP.
My current problem is I could not find out who offer aquablation.
y
kenneth1955 dl0808
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Good morning buddy. I just wrote the company Procept Biorbotics that do the Aquablation to see who in the US are doing it. I called the off of a doctor in New York and they will be doing it at the end of the year. I will let you know if I hear anything else Don't give up Ken
kenneth1955 dl0808
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I have been thinking about this for a couple of days. This would be for any procedure. Many doctor's in the UK have writing many paper's on this subject that any procedure that you have for BPH you do not have to get retro. Now if the doctor stays away for the center where the mountain is that is the verumontanum and ejaculatory duct. That will be great. But that does not guarantee you not getting retro. Let me tell you why I have this in my head. They will get rid of the other tissue on both side either by knife, laser or injection. With them doing that They destroy the seminal canal. You get 70 % of the fluid from them The only fluid you will have coming out now will be from the prostate fluid. Now has you heal and the prostate gets smaller the smaller the amount of fluid will be and sometime it will stop all together. Some time I think men are still having there ejaculation but there is not enough force to push it out. I came up with that years ago when I was on Flomax and Rapaflo. It is still in the urethra but the muscle is weak and if you go under your penis and push up to the tip you will see some fluid. It is all about the muscles being in working orders..They have to fine a way to save the seminal canal if you what the full thing. DL I was also reading about the catheter balloon. Don't you think that the bleeding with that procedure would block the screen and where the water jet will cut meant be in the way. There is still a trail going on It was started in 2015 and will end 2020. I also found this one statement that I did not like. . The primary safety endpoint is the proportion of subjects with adverse events rated as probably or definitely related to the study procedure classified as Clavien-Dindo grade 2 or higher or any grade 1 event resulting in persistent disability ( Ejaculatory disorder or Erectile dysfunction ) evidenced through 3 months post. Time will tell we just will have to wait Take care all Ken
dl0808 tom86211
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Kenneth1995 is an enoumously helpful person. He is writing to the aquablation co to ask it to provide a list of providers. This list will be very useful to the community as aquablation was just approved by FDA in December 2017 and currently it is very difficult to find out which urologists offer this procedure.
Through info provided by JerseyUrology, I found out that Jersey Urology Group in southern New Jersey offers aquablation to treat BPH. It is offered only by one urologist, Dr. Hirsh whose office is at Somers Point, NJ. The procedure will be performed at Shore Medical Center at Somers Point.
"Dr. Andrew L. Hirsh ....received his Bachelor of Science degree from Cornell University and completed his post-baccalaureate in Premedical Sciences at Columbia University. From there, he went on to medical school at the State University of New York at Stony Brook where he graduated after being inducted to the Alpha Omega Alpha Honor Medical Society.
Dr. Hirsh then completed an internship in General Surgery at Columbia University in New York, and a surgical subspecialty Residency in Urology also at Columbia University. He served as Chief Resident in Urology from 2009-2010. At Columbia, Dr. Hirsh was fortunate to train under numerous leaders in the advancing minimally invasive techniques in Urology. In New York, Dr. Hirsh won second prize at the Valentine Resident Research Contest for his research in advanced urology."
Impeccable resume and I learned that one of his speciatlies is Urolift. Since aquablation is robotic, what the urologist needs to know is to define the cut properly and programs it into the computer. Hirsh's experience is more than adequate.
Again. The CPT code for aquablation is 0421T. My plan BCBS covers it.
hank1953 dl0808
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kenneth1955 dl0808
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dl0808 hank1953
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I am not familiar with Medicare plans.
BCBS= blue cross blue shield.
if u are in New Jersey and has some interest in aquablation, I would call jersey urology group and ask to speak to the person who is in charge of insurance.
i did call the doctor's office, the hospital and the anathesialogy group used by the hospital (it is the hospital which decides which anathesialogy group it uses not the doctor.) they all accept BCBS that is I am 100% covered if I decide to do aquablation.
so far I only know (from published scientific studies by trustworthy urologists) that aquablation's functional outcomes are as good as TURP and it has 10-20% RE. But I really wants to understand the complications.That will be my major task.
a local university has given me a temporary library card so I can access the latest journal. In the next couple weeks, I will sort through all the trial results and will post it here when possible.
dl0808 kenneth1955
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hello Ken,
u are very resourceful, I don't how u found out about dr Hirsh, who offer aquablation. I got it from JerseyUrology.
thanks again for ur help.
this thread started about a year ago. When there were several free trials going on. FDA approved Aqua in December 2017. Since then, there has been no new posts in this thread. This is odd. Perhaps, when the procedure is not free, then there is little interest.
dl0808
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if I had went for the procedure thinking that I was covered, I would have to pay for everything by myself.
god know why it declined Urolift but will pay for aquablation. The former is a very well established procedure whereas the latter is new hence more unproven. It should have approved Urolift but decline Aqua.
so do be cautious.
kenneth1955 dl0808
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dl0808 kenneth1955
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thanks and I appreciate ur effort. But there is no need to send me those articles as I have access up to 2018 articles. I was in the library this afternoon reading those articles. I just need to sort them out to convince myself it has less complications than HoLEP.
i believe I understand the RE part. If indeed aquablation is free from incontinnence, then it definitely is a significant advantage over HoLEP. I think that no one can answer this question, except urologists who had done aquablation before such as Hirsh or GIlling.
kenneth1955 dl0808
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Buddy I don't remember if I told you what happen when I had my Urolift. It was only 6 month's from when they started to offer it. I was my doctor 20 th patients to have it done. I had it done April 27, 2015. 4 week before that is when we decide to do it. Went to get it scheduled they got the approval before I left the office. I have well care. I even got a letter from them. I paid $200 for the surgery center. 2 weeks later I get a letter from my insurance saying my procedure was denied. I had to call my insurance and tell them what they sent me. I told them if they wanted I would send a copy of the first paper that they sent. 2 weeks later I got another letter. This one got me. It said that it was denied or reduced. It said I owned them a penny. It is all in the coding that is was my doctors office said. I have been seeing if I can find your BCBS Insurance. I do not know what kind it is. I found Horizon, Empire and Anthem of New Jersey. Also found BCBS of North Carolina I read there list. It did say that it would be covered if you meet with the critiria. It also gave 4 codes . Well I will let you know when I get the information from BioRoberts. Take it easy Ken
kenneth1955 dl0808
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dl0808 kenneth1955
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Indeed, there are a lot of details I don't understand about aquablation or Waterjet treatment.
it is a tissue removal procedure. I note that unlike tissue ablation procedures such as turp, GLL or HoLEP, where heat is used to vaporize or separate the tissues for removal . For Aqua the big claim is "heat" is not generated. Tissues are removed by bruteforcely tearing them apart like sand blasting. Also Whatever heat is generated by the tearing proces will be cooled down by the saline water jet.
another difference is no coagulation. In GLL and HoLEP, during cutting, the laser beam also coagulate by sealing off the blood vessels, whereas in Aqua after the tissues are blasted off by the Waterjet, the tissues surfaces are left alone. Perhaps, this is the reason, why some patients needed a vast amount of saline to flush the bladder through the catheter.
what are the benefits of a COOL removal of the adenoma and what are the side effects of letting the tissue surfaces uncoagulated? What exactly are the side effects that are different than with TURP and HoLEP? These are the issues I hope to understand.
i believe that stability and durability of functional outcomes are not an issue. There is a paper which says that if the functional outcomes lasted for a year then it would probably last for five years or more.
dl0808 kenneth1955
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Preaurthorization from the insurance company is the only sure way that the insurance company will pay for the procedure. This will include the facility or hospital cost and charge by the anathesialogist. Had u done so before ur Urolift, it would have saved u the anguish.
kenneth1955 dl0808
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