Benign Prostatic Hyperplasia, commonly known as BPH, is a widespread condition where the prostate gland enlarges, leading to uncomfortable urinary symptoms in aging men. This growth can compress the urethra, causing problems like a weak urinary stream, frequent nighttime urination, and the sensation of incomplete bladder emptying. Aquablation is a minimally invasive surgical therapy that has emerged as an option for treating BPH. The procedure is designed to remove the excess prostate tissue obstructing the urinary flow, offering a precise and personalized approach to long-term symptom relief.
How the AquaBeam System Works
The core of Aquablation therapy is the AquaBeam Robotic System, which utilizes a heat-free, high-velocity stream of sterile saline to resect obstructive prostate tissue. This method is distinct because it avoids using thermal energy, which can potentially damage surrounding nerves and tissue that control sexual and urinary function. The system’s advanced technology allows for the precise removal of tissue, regardless of the prostate’s size or shape.
Before the actual tissue removal begins, the surgeon creates a personalized surgical map using real-time, multi-dimensional imaging. This planning phase combines digital cystoscopy, which provides a view inside the urethra, with transrectal ultrasound images, which give a comprehensive view of the prostate. This integrated visualization allows the surgeon to meticulously outline the exact area of the prostate to be removed while consciously avoiding structures responsible for continence and ejaculation.
Once the surgical map is finalized, the robotically controlled system takes over to perform the ablation. The robotic arm precisely follows the surgeon’s pre-determined plan, ensuring consistency and accuracy in the tissue resection.
What Happens During the Procedure
Aquablation is performed in a hospital setting and requires the patient to be under anesthesia, typically either general or spinal. The surgeon accesses the prostate using a transurethral approach, eliminating the need for any external incisions. The AquaBeam system’s probe is advanced through the urethra to the prostate, allowing for the real-time visualization and mapping phase.
The actual ablation phase, where the water jet removes the obstructive tissue, is remarkably fast, often lasting only a few minutes. This speed contributes to a shorter total time spent in the operating room, typically less than one hour from start to finish. Following tissue removal, the surgeon may use a minimal amount of cautery to seal any blood vessels and manage bleeding.
A temporary urinary catheter is placed immediately after the procedure to help drain urine and manage post-operative bleeding and swelling. It may also be used to continuously rinse the bladder to prevent blood clots. The patient is then moved to a recovery area for monitoring as the anesthesia wears off.
Recovery and Expected Outcomes
Most individuals spend one night in the hospital following the Aquablation procedure. The catheter is generally removed before discharge if the patient can urinate successfully, though some may go home with it temporarily if they have difficulty emptying their bladder. Once home, patients are advised to avoid strenuous activity or heavy lifting for about 48 hours.
Common, temporary post-operative effects include mild burning during urination, which can last for one to two weeks, and small amounts of blood in the urine for a few days. Patients may also experience a frequent or urgent need to urinate, or a slower flow for a few weeks as the treated area heals. These symptoms are manageable with mild pain medication and typically resolve as the body recovers.
The long-term outcomes for symptom relief are comparable to traditional surgical treatments like transurethral resection of the prostate (TURP). Studies show that improvements in symptom scores and urinary flow rates are sustained for at least three to five years. For men with larger prostates, the improvement in symptom scores may be larger with Aquablation compared to TURP.
A significant advantage of Aquablation is the low rate of sexual side effects. The ability to precisely map and avoid structures controlling ejaculation results in a much lower risk of retrograde ejaculation compared to other procedures. Clinical data indicates that the rate of ejaculatory dysfunction is substantially lower after Aquablation than after TURP. Furthermore, the procedure has not been shown to negatively affect erectile function.