Aquablation is a modern, minimally invasive surgical procedure developed to treat the symptoms of an enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH). The procedure utilizes a robotic-assisted system and a high-velocity stream of water to precisely remove excess prostate tissue that obstructs the flow of urine. This approach relieves lower urinary tract symptoms (LUTS) like frequent urination, weak stream, and incomplete bladder emptying. Unlike older surgical methods, Aquablation is heat-free, which minimizes the risk of thermal damage to surrounding tissue.
How the Aquablation System Works
The system, often referred to as the AquaBeam or HYDROS Robotic System, uses a specialized device inserted through the urethra to access the prostate. The core mechanism, called hydro-ablation, employs a powerful, controlled stream of saline solution to surgically remove the obstructive prostate tissue. This water jet removes tissue at high speed, significantly reducing the total time the patient spends under anesthesia.
The process is guided by real-time, multi-dimensional imaging, combining a standard cystoscope camera with transrectal ultrasound. The surgeon uses these tools to create a custom, digital map of the prostate gland, precisely outlining the tissue to be removed and the structures to be protected. This detailed mapping is crucial for preserving structures responsible for continence and sexual function, such as the ejaculatory ducts and the external sphincter.
Once the surgical map is established, the robotic arm autonomously executes the plan by delivering the heat-free water jet. The robotic precision ensures that the tissue removal aligns exactly with the surgeon’s pre-determined plan, offering a high degree of consistency and predictability. Since the procedure does not rely on burning or cutting, it avoids the thermal injury often associated with traditional electrocautery or laser treatments.
Who is a Candidate for Aquablation
Aquablation is recommended for men experiencing moderate to severe LUTS due to BPH, particularly when medications have failed to provide adequate relief. Patients whose symptoms significantly impact their quality of life, such as frequent nighttime urination (nocturia) or a persistent feeling of incomplete emptying, are strong candidates. Before the procedure, a thorough assessment is conducted, often including the International Prostate Symptom Score (IPSS), a urine flow rate test (uroflowmetry), and possibly a flexible cystoscopy.
A major advantage of Aquablation is its ability to treat prostates of nearly any size and shape, including very large glands unsuitable for other minimally invasive treatments. The technology has demonstrated effectiveness across a broad spectrum of prostate sizes. Candidates must be in good health and free of active urinary tract infections or untreated bleeding disorders.
Preparing for the Procedure and the Surgical Process
Preparation involves a preoperative assessment to ensure the patient is medically cleared for surgery. Physicians advise patients to stop taking blood-thinning medications for a specified period before the procedure to minimize bleeding risk. The procedure is performed in a hospital setting and requires either general or spinal anesthesia to ensure patient comfort and immobility during the robotic treatment.
Once anesthesia is administered, the surgeon inserts the specialized instrument, which contains a camera (cystoscope) and an ultrasound probe, through the urethra. This transurethral approach means no external incisions are necessary. The surgeon uses the real-time ultrasound and cystoscopy images to meticulously map the prostate, defining the precise boundary of the tissue to be removed and the areas to be spared.
After mapping is complete, the robotic system delivers the high-velocity water jet, which typically takes less than ten minutes to ablate the planned tissue. Once the tissue is removed, the surgeon may perform a brief, localized cauterization, usually at the bladder neck, to seal any exposed blood vessels for hemostasis. The entire procedure is completed in under one hour.
Recovery Timeline and Long-Term Results
Patients typically wake up with a temporary urinary catheter in place, which drains the bladder while the treated area heals. Most individuals require an overnight stay in the hospital for observation, ensuring they can urinate effectively after the catheter is removed. For a few weeks following the procedure, patients may experience mild discomfort or a burning sensation during urination, which is a normal part of the healing process.
Light activities can usually be resumed within a few days, but patients are advised to avoid heavy lifting or vigorous exercise for at least two weeks. Long-term results from Aquablation are promising, showing significant and sustained improvement in urine flow rates and a substantial reduction in LUTS. A notable benefit is the lower rate of sexual side effects, particularly ejaculatory dysfunction, compared to older surgical methods, due to the procedure’s precision.