Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Four out of 5 experts were familiar with or had used this technology before.

Level of innovation

All of the experts agreed that this is a novel technology. Two of the experts said that Aquablation therapy is an ultrasound-guided procedure with advanced planning software to draw contours specific to each individual's anatomy. This feature helps protect key areas of the prostate, such as the ejaculatory ducts, to maintain normal ejaculation. Two experts also said that the technology uses an automated robotic approach to remove prostate tissue via a water jet rather than heat, which most other technologies use.

Potential patient impact

Three experts said that the technology is a safer and more effective treatment for patients, because it carries a lower risk of negative side effects relating to sexual function. The technology has been shown to offer improved rates of maintenance of ejaculation and erection. Two experts mentioned the importance of being able to use the technology with patients who have large or complex prostate anatomy. Both the shape and the size of the prostate are a limiting factor for other technologies used in standard care. Three experts also commented on the shorter procedure time compared with standard care, and the potential to provide day-case procedures. All of the experts said that people with large prostates and those who are keen to preserve sexual function would particularly benefit from using this technology.

Potential system impact

One expert said that the technology has the potential to replace current standard care because of its efficacy and potential to be used with nearly all sizes of prostate. Three other experts felt that the technology would be used in addition to standard care. The consensus was that the technology has the potential to replace transurethral resection of the prostate and will challenge holmium laser enucleation of the prostate for larger prostates. All of the experts agreed that the initial capital outlay and consumable costs are higher compared with standard care. Some of the experts highlighted the potential cost savings based on the efficiency gains related to completing more procedures per day and reducing hospital stay.

General comments

All of the experts commented that specific training is required before doing procedures and that this is provided by the company. Ongoing training through observation and onsite support is also in place. The experts suggested that the learning curve is relatively short and that no changes to clinical facilities are needed to do the procedure. It was also highlighted that the initial blood transfusion rate following Aquablation therapy was high, but the introduction of focal bladder neck cautery has addressed this issue with a much lower rate of blood loss and rectal perforation being observed.