LCD Reference Article Response To Comments Article

Response to Comments: Transurethral Waterjet Ablation of the Prostate

A59280

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Source Article ID
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Article ID
A59280
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Transurethral Waterjet Ablation of the Prostate
Article Type
Response to Comments
Original Effective Date
12/15/2022
Revision Effective Date
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The comment period for the Transurethral Waterjet Ablation of the Prostate DL38549 Local Coverage Determination (LCD) began on 9/1/22 and ended on 10/15/22. The notice period for L38549 begins on 12/15/22 and will become effective on 1/29/23. The comments below were received from the provider community.

Response To Comments

Number Comment Response
1

I am a board-certified urologist. I routinely perform Aquablation for my patients and have successfully completed over 80 cases with excellent results. The average size of the men I have treated with Aquablation is greater than 100 grams which is just another testimony to the efficacy of Aquablation, even in difficult patients.

I would like to support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38549) that removes the coverage criteria to only cover men 80 years old or less. It is a general fact, that the older the man the larger the glands, which make Aquablation with its ability to treat all shapes and sizes of prostates even more attractive in octogenarians.

In working for the past 20 years with men’s health and with men who have BPH with LUTS, I have never developed a treatment plan based on their age. Men of all ages deserve the same opportunity to have a successful outcome and men over the age of 80 also have a desire to maintain sexual function and avoid certain complications which the five-year Aquablation data has shown. Furthermore, considering octogenarians have more medical health issues, making other treatment +options such as HoLEP or simple prostatectomy more risky than Aquablation.

As a surgeon or a patient, it is shocking that any exclusion of a treatment modality for any condition based on age would be considered acceptable. Especially BPH, which can more negatively affect older men and their quality of life and medical health more than their younger counterparts. This coupled with the fact no other BPH therapy is linked to age makes me question the validity of this restriction.

Finally, let me close by stating that preventing any patient's access to a procedure based solely on their age seems discriminatory. I know of no other treatment in medicine that has an exclusion criteria based solely on the patient's age and I feel confident that the American Urological Association would not support any such exclusion criteria.

I strongly encourage the reviewers to consider these facts and immediately remove any age requirement for the treatment of men who suffer from BPH and allow all men to have the option of Aquablation and the safety, efficacy and durability it offers.

Thank you for your informed comments and support regarding this policy.

2

I am a board certified urologist. I am routinely performing Aquablation for my patients. My partners and I have now done close to 160 cases in the past 11 months and have seen tremendous outcomes in our patients with minimal complications at the time of surgery or post-operatively. Our patients are very pleased with their outcomes.

I would like to support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38549) that removes the coverage criteria to only cover men 80 years old or less. This is a very safe procedure and there is a tremendous need for this procedure in the over 80 age group that would benefit significantly. It’s a travesty that they do not have access to this procedure given the current restrictions.

Thank you for your attention to this matter and I hope for a favorable outcome.

Thank you for your informed comments and support regarding this policy.

3

I am a board certified urologist. I am routinely performing Aquablation for my patients. I have performed over 30 procedure in the past couple of year. I typically perform this procedure instead of a TURP. Aquablation has significantly less side effects and preserves sexual function better than TURP. This also helps patients have a transurethral procedure instead of an open or robotic procedure.

I would like to support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38549) that removes the coverage criteria to only cover men 80 years old or less. Patients over 80 years of age typically have large prostates and would need to have an open or robotic procedure. We are now able to do a transurethral procedure to help these patients rather than a robotic or open procedure. Time under general anesthesia is far shorter than the open or robotic procedures; therefore aquablation is a safer approach.

Thank you for your consideration.

Thank you for your informed comments and support regarding this policy.

4

I am a board certified urologist. I am routinely performing Aquablation for my patients. I have performed Aquablation on over 130 patients over the past two years. I have experienced no significant complications relative to the procedure other than normal post-operative complications in line with other BPH surgeries. I have done Aquablation on multiple patients over the age of 80 and they have done well.

I would like to support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38549) that removes the coverage criteria to only cover men 80 years old or less. As I have said, I have done multiple procedures on patients over 80. The procedure being robotic cuts down on anesthesia time, fluid used during the procedure and catheter time post operative. All of these things cut down on readmissions or prolonged hospital stay after the surgery in patients over 80. It also cuts down on the need for skilled nursing facility or rehabilitation centers after surgery. Feel free to contact me with any questions or concerns.

Thank you for your informed comments and support regarding this policy.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L38549 - Transurethral Waterjet Ablation of the Prostate
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Public Versions
Updated On Effective Dates Status
12/09/2022 12/15/2022 - N/A Currently in Effect You are here

Keywords

  • BPH
  • Aquablation
  • Aquabeam
  • TURP
  • Fluid Jet