What is prostate aquablation?
Benign prostatic hyperplasia (BPH), also known as prostate adenoma, is a common condition among older men. It frequently leads to lower urinary tract symptoms (LUTS), such as frequent urination, weak urinary stream, and a sensation of incomplete bladder emptying. Traditionally, transurethral resection of the prostate (TURP) has been considered the "gold standard" of treatment [1]. However, with the advancement of medical technologies, new and less invasive methods have emerged, one of which is aquablation.
Aquablation is an innovative technology that uses robotically controlled water jets to remove soft prostate tissue. The procedure is performed under the guidance of a surgeon who defines the target area for ablation. This method quickly and effectively relieves LUTS caused by BPH [1].
Prostate adenoma (BPH): when is treatment required?
Prostate adenoma is a non-cancerous enlargement of the prostate gland that can compress the urethra, impeding urine outflow. Symptoms can range from mild to significantly worsening the quality of life. If conservative treatments (lifestyle changes, medications) do not yield the desired result or the patient's condition worsens, surgical intervention may be required.
The goal of BPH treatment is to relieve urinary tract obstruction, improve symptoms, and prevent complications such as urinary tract infections, bladder stones, or renal failure. The choice of treatment method depends on prostate size, symptom severity, the patient's general health, and their preferences.
Aquablation versus traditional methods: advantages
The advent of aquablation has been a significant step forward in the treatment of BPH. In direct comparison to TURP, aquablation demonstrates equivalent objective outcomes while offering several substantial advantages:
- Improved side effect profile: One of the key advantages of aquablation is a significantly improved adverse event profile, with a particular focus on the preservation of postoperative sexual function [1]. This is critically important for many men who fear the loss of erectile or ejaculatory function after traditional surgeries.
- Reduced resection time: The aquablation procedure is characterized by a significantly shorter resection time compared to TURP [1]. This helps reduce the overall operation time and potentially minimizes the risks associated with prolonged anesthesia.
- High precision: The use of machine control ensures high precision in tissue removal, minimizing damage to surrounding structures.
These factors make aquablation an attractive alternative for patients seeking effective BPH treatment with minimal impact on their quality of life.
How is the aquablation procedure performed?
The aquablation procedure is performed using a specialized robotic system. The main steps include:
- Planning: The surgeon uses ultrasound imaging to create a three-dimensional map of the prostate and precisely define the area of the adenoma that needs to be removed. At the same time, important anatomical structures responsible for erectile and ejaculatory functions are preserved.
- Ablation: After planning, the robotic system directs high-speed water jets to precisely remove excess prostate tissue. This process occurs without the use of heat, which reduces the risk of thermal injury to surrounding tissues.
- Monitoring: The surgeon continuously monitors the process, ensuring the safety and efficacy of the procedure.
The WATER II study, which focused on aquablation in men with large prostate volumes (80-150 mL), showed the following results: the average prostate volume was 107 mL. The average operation time was 37 minutes, and the aquablation resection time itself was only 8 minutes. Adequate adenoma resection was achieved in a single pass in 34 patients, while the remaining required additional passes [2]. This demonstrates the effectiveness of the method even with significant gland sizes.
Results and safety of aquablation
Clinical studies confirm the high efficacy and favorable safety profile of aquablation. The procedure rapidly relieves lower urinary tract symptoms associated with BPH [1].
As part of the multicenter prospective WATER II study, which involved 101 men with moderate to severe BPH symptoms and prostate volumes ranging from 80 to 150 mL, data on early safety and feasibility of the method were obtained. Adverse events during the first month after surgery were rigorously tracked and evaluated by an independent clinical events committee [2]. The results showed that aquablation is a safe and effective treatment method, especially for patients with large prostates for whom traditional methods may be more complex or risky.
It is important to note that aquablation provides equivalent objective outcomes compared to TURP while significantly reducing resection time and improving the side effect profile, making it an attractive choice for many patients [1].
Conclusion and prospects
Prostate aquablation represents a significant breakthrough in the treatment of benign prostatic hyperplasia. This innovative method offers patients an effective and safe solution for relieving BPH-related symptoms while minimizing risks and preserving vital functions, such as sexual function. Thanks to the precision of robotic control and the use of water jets, aquablation is a promising alternative to traditional surgical interventions, especially for men with large prostate volumes. As long-term data accumulate, aquablation is likely to secure an increasingly firm place in the urologist's armamentarium, offering men an improved quality of life.
References
- [1] Aquablation of the prostate: a review and update. (The Canadian journal of urology, 2019). Prostate aquablation: a review and update.
- [2] WATER II (80-150 mL) procedural outcomes. (BJU international, 2019). WATER II (80-150 mL) procedural outcomes.
The information presented in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and the selection of an optimal treatment plan.