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Aquablation for Benign Prostatic Hyperplasia

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Aquablation is a novel non-invasive robotic surgery indicated for benign prostatic hyperplasia. Read the article below.

Written byDr. Shaivy Dubey

Medically reviewed byDr. Shivpal Saini

Published At September 13, 2023
Reviewed AtDecember 29, 2023

What Is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) is a disorder of the prostate; it occurs when the surrounding tissue expands. As the benign prostatic hyperplasia grows, it starts causing problems. The prostate has two major growth periods in a man's age. The first is puberty when the prostate gland increases in size. The second begins around the age of 25 years and continues during a man's life. As men age, the prostate may get larger.

The prostate is the size of a walnut in adult men, and it can grow to be as large as the size of an orange. As the gland enlarges, it can suppress the urethra. The bladder wall becomes thicker. Eventually, the bladder may get weak and lose the ability to empty completely. Urine then remains in the bladder for a longer time. These problems result in many of BPH's lower urinary tract symptoms (LUTS). If a person cannot pass urine (called retention) or has renal failure, immediate medical treatment is required. But, some other symptoms like weak urine stream or the need to push or put a strain on the muscle can many times be taken care of.

Benign prostatic hyperplasia (BPH) is a benign disorder. This means it is not cancer, nor does it result in cancer. Still, benign prostatic hyperplasia (BPH) and cancer can happen at the same time. Benign prostatic hyperplasia may not need any treatment, but if it starts causing any symptoms, treatment can help. It is reported that half of all men between ages 51 and 60 suffer from BPH. It is reported that around 90 % of men over the age of 80 have it. Many treatments can help BPH. These include medicines, surgery, and other procedures. Aquablation therapy is one of the noninvasive therapies for it.

When Should a Patient Consider Treatments Beyond Medication for BPH?

Medications also help to treat BPH, but it is observed that some medication therapy may fail in some cases. Failure means that symptoms will continue to progress despite using medications.

Medication therapy may also be less effective or late for people whose symptoms have already progressed to a severe stage.

What Is Aquablation Therapy?

Aquablation is a new, FDA (Food and Drug Administration) approved procedure for the treatment of BPH or enlarged prostate. It is unique and fancy because it uses a robotic system to provide a heat-free water jet to remove overgrown prostate tissue. Aquablation therapy is an effective and safe treatment for patients suffering from problems like lower urinary tract symptoms (LUTS) caused by BPH. It can be indicated for prostates of any size and shape.

Aquablation therapy is a non-incision, minimally invasive procedure that removes symptomatic prostate tissue by accessing it through the urethra.

The following are some more points on new treatments for BPH.

  • Aquablation therapy is the only kind of procedure that uses a heat-free water jet controlled by robotic technology to remove prostate tissue.

  • In addition, it is one of the procedures that involve a camera called a cystoscope with ultrasound imaging, giving the doctors the ability to see the entire prostate.

  • Aquablation therapy offers precise, consistent, and predictable results, ensuring long-term relief for patients.

  • It is reported that patients who had aquablation therapy had a low rate of complications like incontinence, ejaculatory dysfunction, and erectile dysfunction.

What Is the Procedure of Aquablation Therapy?

Aquablation therapy is considered a robotic surgery that eliminates prostate tissue with the help of the power of water. The treatment is performed under anesthesia in a hospital. The operation takes less than one hour and involves an overnight stay.

There are two critical steps to the procedure:

Step 1

  • Mark a surgical map.

  • In every patient, the prostate is different in size and shape, so it is crucial for a doctor to modify the surgery to the patient's specific anatomy and physiology.

  • Aquablation therapy is the only procedure that includes a camera called a cystoscope with ultrasound imaging, and the surgeon gets the ability to see the entire prostate in real-time.

  • Ultrasound imaging in aquablation therapy helps the surgeon to mark which parts of the prostate have to be removed and which parts to save.

  • The surgeon will work to avoid any irreversible complications around the prostate gland. Complications like erectile or ejaculatory dysfunction, and incontinence.

Step 2

  • Removing the prostate tissue.

  • According to the surgical plan, a robotically-controlled, heat-free water jet removes the prostate tissue that has been marked out. This robotic technology reduces human error while removing the prostate tissue and ensures the prostate tissue is removed precisely.

  • It should be noted that some doctors may use a minimal amount of cautery in the aquablation procedure to control excessive bleeding.

How Does Aquablation Work?

The aquablation therapy procedure is mostly performed under general anesthesia. Once the patient is under anesthesia, the doctor will start by placing an ultrasound scope into the rectum. Then the cystoscope will be introduced into the bladder through the urethra. Next, the robotic arm will be attached to the cystoscope. The camera that is attached to the cystoscope, and the images produced by the ultrasound probe, will project onto a screen for the doctor. With all clear visualization, the surgeon can precisely mark the areas to be removed and identify some avoidable anatomical areas within close proximity. Because each patient's prostate and treatment plan is different, this imaging also helps the surgeon to target tissue to be removed precisely.

The robot will produce a high-velocity, unheated, sterile saline that will follow the exact marking outlined by the doctor. During the procedure, the surgeon will have a complete view of the prostate, the resection procedure, and machine control while performing the procedure. However, at any time, the doctors can stop the procedure in order to make some major or minor adjustments if necessary.

Why Should a Person Opt For Aquablation Therapy?

Aquablation therapy stands out as a distinct surgical treatment option for BPH due to three key reasons.

1. Low Rates of Complications:

Aquablation therapy has a very low rate of complications like incontinence, ejaculatory dysfunction, and erectile dysfunction because of the following:

View of the Complete Prostate with Ultrasound Imaging:

Aquablation therapy is the procedure that uses a camera cystoscope along with ultrasound imaging to identify the prostate gland and its abnormality. This helps the surgeon to see the entire prostate so they can mark a surgical map of the areas of the prostate to plan the procedure to remove the extra tissue. In other available surgical procedures, the surgeon may not be able to see the prostate due to the limitation of the camera (cystoscope). This limits the surgeon's ability, and they may face some problems like erectile function, ejaculatory function, and incontinence.

Heat-free Waterjet Technology:

Aquablation therapy is a procedure that may use a heat-free water jet to eliminate the overgrown prostate tissue. Resective procedures may use heat to remove prostate tissue, and heat may damage the parts of the prostate that control other functions like erectile function and ejaculatory. It is observed that some surgeons may opt for minimal use of cautery in the aquablation procedure to control bleeding. In clinical studies, men with aquablation therapy had a shallow rate of irreversible complications—incontinence, ejaculatory dysfunction, and erectile dysfunction.

2. Confidence in Procedure:

Aquablation therapy is a robotic procedure that utilizes a controlled water jet to remove prostate tissue. This advanced technology reduces the risk of human error and enables precise removal of prostate tissue.

3. Long-Term Relief:

In many clinical studies, it is observed that aquablation therapy has been shown to give long-term relief at three years.

How Is the Recovery of Aquablation Therapy?

As with most BPH procedures, the patient will need a catheter, which allows the patient to pee while the urethra heals completely. patients usually spend one night in the hospital. Before being discharged, the doctor typically removes the catheter and discusses further instructions with the patient. If a patient cannot pee on their own and empty the bladder, the doctor may discharge the patient with a catheter for some days or keep the patient an additional night in the hospital. The advantage of aquablation therapy is that most patients get discharged from the hospital without a catheter. Once the patient is home, they may experience mild burning during urination for some weeks after the procedure. This can be managed with painkillers and analgesics. Patients can get back to their regular activities once approved by their doctor.

Conclusion

In conclusion, aquablation therapy is a modern procedure for treating prostate enlargement. It uses a precise waterjet to remove excess prostate tissue, providing relief from urinary symptoms. It has advantages over traditional surgery, such as preserving healthy tissue and improving long-term urinary function. However, there are potential risks, including infection and urinary problems. It is important to discuss the benefits and risks with a healthcare provider to make an informed decision. Aquablation therapy can be a good option for prostate enlargement treatment, but it is essential to consult with the doctor prior to undergoing the procedure.

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Frequently Asked Questions

Because BPH and prostate cancer share risk variables, including age and hormones, BPH, or benign prostatic hyperplasia, is linked to a higher chance of prostate cancer. Although BPH is not malignant in and of itself, it occasionally coexists with prostate cancer or causes symptoms that need additional testing. Frequent prostate screening is necessary for both disorders' early diagnosis and treatment.

Medication therapy, minimally invasive treatments such as laser therapy or transurethral resection of the prostate (TURP), and surgical techniques like open prostatectomy are the available treatment methods for bipolar disorder (BPH). The intensity of the symptoms, the patient's preferences, and the existence of additional medical issues all influence the therapy option. In order to choose the best course of therapy, the patient and the healthcare professional must collaborate in decision-making.

A healthy weight, regular exercise, abstaining from coffee and alcohol, and pelvic floor exercises are just a few lifestyle changes that can help reduce BPH symptoms and enhance prostate health in general. Combining these lifestyle modifications with medical care can improve quality of life and symptom control.

BPH symptoms may typically be effectively managed with medications such as alpha-blockers and 5-alpha reductase inhibitors, especially when the condition is mild to moderately severe. However, each person responds differently to them, and there is a chance they have adverse effects to take into account. Regular monitoring by a healthcare practitioner is required to evaluate therapy response and make appropriate pharmaceutical regimen adjustments.

When medical therapy and conservative measures are ineffective for treating BPH, or when problems like urinary retention or recurrent UTIs occur, surgical surgery becomes critical. While surgical alternatives provide greater urine function and long-term symptom alleviation, they come with risks that need to be carefully weighed against advantages.

Ignoring BPH symptoms can result in increased symptoms related to the urinary system, a worse quality of life, urinary tract infections, bladder stones, acute urine retention, and, in extreme situations, kidney damage. To avoid difficulties and preserve ideal prostate health, it is crucial to identify and treat BPH symptoms as soon as possible.

The efficacy of natural therapies like saw palmetto, pygeum africanum, and stinging nettle root extract to relieve BPH symptoms is still up for dispute, so people should speak with their doctors before using them. To guarantee safety and effectiveness, integrating natural medicines with conventional treatments should be carried out under the supervision of a healthcare provider.

Active strategies to delay the formation of BPH include leading a healthy lifestyle, engaging in regular exercise, and controlling chronic illnesses like diabetes and obesity, which increase the chance of developing BPH. Proactively implementing preventative measures can lower the risk of developing BPH and improve prostate health in general.

Growing older is a major risk factor for the development of BPH, and the condition is more common as people age. Prostate development is influenced by aging-related hormonal changes, namely variations in testosterone and estrogen levels. It is critical to have periodic prostate health evaluations in medical treatment, particularly as men age.

Prostate cancer and BPH have different pathologies and symptoms. Prostate cancer symptoms might include blood in the urine or semen, erectile dysfunction, and bone pain, but BPH symptoms are mostly related to urinary problems such as frequent urination, urgency, weak urine stream, and incomplete emptying. Accurate assessment and management of these illnesses depend on a healthcare professional's ability to differentiate between patients.

The frequency of BPH screening that is advised for men varies according to their unique risk factors and symptoms. In general, screening may be advised every year or every few years for men over a certain age, especially if they have risk factors, including a family history of the condition or symptoms that point to BPH. Frequent screenings lower the risk of problems from untreated BPH by enabling early identification and treatments.

BPH symptoms include decreased libido, ejaculatory dysfunction, and erectile dysfunction, which might affect one's ability to have a sexual life. These symptoms might be caused by an enlarged prostate physically obstructing the urethra or by adverse drug reactions from BPH treatments. To treat BPH and its symptoms completely, open conversation about sexual health issues is crucial with healthcare professionals.

Reduced consumption of caffeine, alcohol, and spicy meals, increased consumption of fruits, vegetables, and fiber-rich foods, and plenty of water consumption are dietary recommendations that may help control the symptoms of BPH. In addition to supporting general prostate health, a well-balanced diet low in irritants and high in nutrients can help reduce symptoms of BPH.

When someone thinks they may have BPH, they should get checked out by a medical professional. They can conduct a physical examination, evaluate symptoms, and suggest additional tests like imaging studies, a PSA test, or a urinalysis to confirm the diagnosis and decide on the best course of treatment. BPH can be stopped in its tracks, and the prognosis of those who are afflicted can be improved with early detection and treatment.

Factors contributing to the heightened risk of BPH development include advancing age, family history of BPH or prostate cancer, obesity, sedentary lifestyle, certain medications, and hormonal imbalances, particularly changes in testosterone and estrogen levels. Awareness of these risk factors can help individuals and healthcare providers identify those at increased risk and implement preventive measures and early interventions.

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Dr. Shivpal Saini from iCliniq
Dr. Shivpal Saini

General Surgery

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