January 31, 2024
SPOTLIGHT ON: Aquablation as Treatment for BPH
Benign Prostatic Hyperplasia (BPH) is a common urologic concern that impacts the quality of life for as many as 14 million American men, especially as they age. Estimates suggest more than 50 percent of men in their sixties are affected by some degree of BPH, and that number increases sharply with each additional decade of life. BPH symptoms can range from mild — such as dribbling at the end of urination, to more severe — including urinary retention and incontinence. Many men “live with” BPH and its negative impact on the quality of their lives. But newer, minimally invasive treatments are available today — to help them get the relief they need to live otherwise happy and active lives.
For many men, lifestyle changes such as exercise, limiting liquid intake before bedtime, a healthy dietary plan, and slight changes in urination habits can help lessen the symptoms associated with BPH. However, a more potent treatment approach may be necessary for those men experiencing the more severe effects of the condition. Medication therapy is a standard treatment for men with mild to moderate prostate enlargement. However, surgery may be necessary for those with more severe forms of the condition — especially if they are unable to urinate correctly or if the enlarged prostate is impacting proper kidney or bladder function.
A minimally invasive, no-incision procedure called Aquablation is one of the newer techniques for the treatment of men with lower urinary tract symptoms due to an enlarged prostate. This procedure aims to remove prostate tissue that is obstructing the urinary channel to allow for improved urinary flow. Performed by a trained urologic surgeon, Aquablation uses highly pressurized water to remove excess prostate tissue blocking the urethra. This tube carries urine from the bladder out of the body. To perform the Aquablation technique, the surgeon uses a computerized system to map out the treatment area of the prostate. The pre-programmed area is then automatically treated by the Aquablation system through the urethra. This procedure opens the prostate, allowing urine to pass through a wider opening as it exits the prostate into the rest of the urinary channel.
There are multiple potential benefits to using Aquablation over other, more traditional surgical treatments for BPH. For instance, the area of treatment can be programmed in such a fashion as to ablate the anterior or top of the prostate to avoid ablation of the prostate tissue closer to the ejaculatory ducts. Doing so significantly reduces the risk of a possible side effect called retrograde ejaculation. Retrograde ejaculation means that at the time of orgasm, the ejaculatory fluid will not exit the penis but rather will enter the bladder. In this case, the man will still experience ejaculation, and the orgasmic feeling will still be intact — but no seminal fluid coming out of the penis. Retrograde ejaculation is a common side effect of other types of prostate ablative procedures, such as Transurethral Resection of the Prostate, Transurethral Laser Vaporization of the Prostate, and Transurethral Laser Enucleation of the Prostate. While these procedures have a very high rate of retrograde ejaculation, Aquablation offers a much smaller chance of causing this problem.
Additional potential benefits of Aquablation may include shorter hospital stays and faster recovery times than traditional surgery, targeted removal of tissue that can help preserve healthy tissue, reduced risk of erectile dysfunction and urinary incontinence, and long-term relief from BPH symptoms.
Currently used only for the treatment of BPH, Aquablation is rapidly becoming available at many institutions in the US. However, there are some treatment risks when it comes to this procedure. Aquablation treatment potentially has a higher rate of post-operative bleeding and a subsequent need to return to surgery to stop the bleeding. To reduce the bleeding risk, once the Aquablation procedure is complete, the surgeon will perform a cystoscopy resection and vaporization of the areas that Aquablation treated to cauterize or seal off any open vessels.
Aquablation is usually indicated for prostates that are below 80 grams (a normal size prostate is 30 grams). Treatment of larger prostates using this Aquablation may lead to a higher risk of bleeding. However, many experienced urologic surgeons will use this technique to treat prostates up to 120 grams. Additionally, specific prostate shapes are not good candidates for Aquablation. These prostates have large middle portions that have grown into the bladder, causing a ball valve effect at the bladder opening. Aquablation will not successfully ablate this part of the prostate.
As with any medical procedure or treatment, Aquablation is not suitable for everyone. Men with certain medical conditions or very large prostates may not be good candidates, as mentioned above. Therefore, all men need to have their urinary symptoms (even those that seem like a minor inconvenience) evaluated by a trained urologic professional to determine what’s causing them. Addressing urologic problems early offers the widest variety of treatment options for solving them – and the best possible outcomes after treatment.
Sources:
https://emedicine.medscape.com/article/437359-overview?form=fpf
