LCD Reference Article Response To Comments Article

Response to Comments: Transurethral Waterjet Ablation of the Prostate DL38682

A59535

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A59535
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Article Title
Response to Comments: Transurethral Waterjet Ablation of the Prostate DL38682
Article Type
Response to Comments
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10/15/2023
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This article summarizes the comments WPS received for Draft Local Coverage Determinations (LCD) Transurethral Waterjet Ablation of the Prostate DL38682. Thank you for the comments.

Response To Comments

Number Comment Response
1

I am a board-certified urologist and I practice at Deaconess Hospital in Evansville, IN. I routinely
perform Aquablation for my patients and have successfully completed over 75 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. Alternatively, these patients would need a more invasive surgery with high risk and greater recovery. Otherwise, many would require a catheter for life.

I support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38682) that removes the 80 yo age restriction. It is generally accepted, 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 10 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 5Y 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.

I encourage the medical policy team to consider these facts and 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.

WPS thanks you for your comments and support of the proposed change.

2

I am a board-certified urologist and practice at the Michigan Institute of Urology throughout Southeast Michigan. I am routinely performing Aquablation for my patients at Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan. I have performed over 85 procedures in the past few of years. 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 support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38682) 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 often a safer approach for these patients.

WPS thanks you for your comments and support of the proposed change.

3

I am a board-certified urologist. I practice in the Kansas City metropolitan area as a member of Kansas City Urology and Oncology Care. I operate at North Kansas City Hospital in North Kansas City, Missouri, among several other hospitals. I routinely perform Aquablation and have performed 30 procedures over the last 9 months. Our group has performed over 175 in the same interval. The outcomes are compatible with a TURP with lower morbidity.

I support the proposed local coverage determination (LCD) Transurethral Water Jet Ablation of the Prostate (DL38682) that removes the coverage criteria to only cover men 80 years old or less. The study referenced to investigate the efficacy and safety of this procedure used an arbitrary age cutoff for patient inclusion. This was not intended to limit the use of Aquablation above this age. I frequently have patients who would benefit from this therapy but do not have access to it because of this arbitrary age cutoff. This group of older men often have large prostates and reasonably desire the lower morbidity and shorter anesthetic times associated with Aquablation in this setting.

We are always looking for safer and better procedures for this population.

WPS thanks you for your comments and support of the proposed change.

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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
L38682 - Transurethral Waterjet Ablation of the Prostate
Related National Coverage Documents
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