Aquablation Therapy
Managing Expectations and Realities

May 16, 2024

The prostate gland is one of seven essential components of the male reproductive system, but it is the only reproductive organ that continues to grow throughout the majority of a man’s life. This may not sound so bad, but ever-growing prostate tissue can begin causing issues as a man reaches his 40s, 50s, 60s, and beyond. There is only so much growth that part of the body can support before the prostate begins encroaching on other organs such as the urethra and bladder. When the enlarged prostate begins affecting urination in a bothersome way, benign prostatic hyperplasia or BPH is typically diagnosed. When lower urinary tract symptoms (LUTS), such as intermittent urination, frequency, urgency, nocturia, or a host of other urinary symptoms brought about by an enlarged prostate, start to interfere with everyday life, an ultrasound guided, robotic-assisted, heat-free waterjet resection for the treatment of benign prostatic hyperplasia, may help with excess prostate volume and turn the tide in a man’s favor.
Expectations can be high with newer treatments for a disease and the Aquablation therapy procedure is no exception. The goal when evaluating any medical procedure is to weigh the advantages vs. the disadvantages and the expectations vs. the realities. Luckily for men currently living with BPH and for those who will be diagnosed with benign prostatic hyperplasia in the future, Aquablation therapy doesn’t disappoint with its advantages or where its expectations meet reality.

Aquablation Therapy Advantages & Disadvantages

Aquablation Therapy Advantages
Any size prostate
Any shaped prostate
Real time imaging via ultrasound and cystoscopy
Heat-free tissue resection
Incision-free
No radiation
Robotic precision
Waterjet to remove obstructive tissue
Individualized treatment plan
Preservation of sexual function1,2
Preservation of continence 1,2
Sphincter preservation
Ejaculatory duct preservation
Advanced mapping software
Predictable tissue resection
No prostate coring
Minimal common side effects 1,2
Strong safety profile 1,2
Long-term relief of BPH 1,2

Aquablation Therapy Disadvantages
May require overnight hospital stay
General or spinal anesthesia
Catheter insertion

Most common side effects (typically mild and transient)
Mild pain
Difficulty urinating
Pelvis discomfort
Blood in the urine
Inability to empty bladder
Frequent urination
Urgency
Bladder infection or UTI

Other side effects
Ejaculatory dysfunction
Urethra or rectum injury
Anesthesia risk
Other infection risk

Other potential risks can be found here.

For more information about potential side effects and risks associated with Aquablation therapy, speak with your urologist or surgeon.

Aquablation Therapy Expectations and Realities

Where do Aquablation therapy expectations meet reality? It is every day in hospitals and surgery centers across the globe as men choose to find a durable solution to their bothersome BPH symptoms. Sometimes in life, expectations ride far ahead of realities. However, it appears that with Aquablation therapy, both expectations and reality are riding side by side as more men discover the advantages of a safe, effective, and durable solution to their BPH issues.
One current expectation with Aquablation therapy is that the procedure can handle any size or shaped prostate, which is being shown by surgeons every day to be a reality.3
Another expectation is that by utilizing a heat-free waterjet and both ultrasound and a cystoscopy camera from different angles, a real-time multidimensional view of the prostate can be obtained to precisely guide the robotically controlled surgical device so important continence and sexual functionality structures can be avoided. This is also being shown to be a reality by surgeons who operate the AquaBeam Robotic System. Per Dr. Bentley of the Cleveland Clinic, “Unlike any other BPH-related surgery, Aquablation is an image-guided procedure allowing for increased precision and ensuring all the important structures, such as the sphincter muscle, blader, and ejaculatory ducts are identified and maintained. Additionally, there is no heat dissipation during tissue removal since this procedure uses a waterjet.”4
And yet another set of expectations for Aquablation therapy in addressing benign prostatic hyperplasia is that it is safe and effective and is developing a reputation for being a durable, long-lasting BPH procedure. According to Dr. Bentley, this too is becoming a reality. “This minimally invasive procedure is safe with long-term durability and a low side effect profile,” he says while noting that Aquablation therapy should be considered for BPH patients who fail medication or those who prefer a surgical approach. “This procedure is also an option for men with larger prostates who might not be candidates for more traditional approaches that have size limitations.” Dr. Bentley has seen first-hand the success stories of Aquablation therapy. “The outcomes we have observed so far have been excellent,” Dr. Bentley notes. “There has been a marked improvement in urine flow and more than a 16-point reduction in AUA symptom score. This procedure has also resulted in a definite preservation of sexual function for our patients … Aquablation is an example of the power of image-guided technology and the impact it can have on patient outcomes and quality of life.”4
An additional expectation for Aquablation therapy is that it can be a lasting solution to LUTS and BPH, compared to medications. Dr. Ricardo Gonzalez, a urologist at Houston Methodist points out that even taking a full load of medication therapy, one in three men will fail to find a solution to their BPH symptoms five years in. This failure means that BPH symptoms will continue to progress despite the use of BPH medications. He also mentions that medication therapy may be too little, too late for men whose symptoms have already progressed to the point where they are moderate to severe. “People used to wait a long time because they feared the complications of prostate surgery, assuming that every surgical option would result in sexual dysfunction and urinary incontinence,” explains Dr. Gonzalez. “With totally robotic surgical approaches like Aquablation therapy, that’s simply not the case anymore.”5
“Since we enter through a natural orifice, the urethra, there are no incisions during this procedure,” Dr. Gonzalez explains. “And the use of image-guided robotics means the tissue is removed with great precision.” Dr. Gonzalez additionally shares his view that, “several other surgical prostate therapies destroy excess prostate tissue using heat or harsh substances, both of which can harm the remaining tissue and likely contribute to some of the sexual dysfunction seen after those procedures.”5

In Summary
The advantages to Aquablation therapy as a surgical treatment for an enlarged prostate by robotically removing excess prostate tissue via a saline waterjet are numerous and impactful for addressing bothersome and life-impacting BPH symptoms. Disadvantages or side effects are typically temporary or transient, however men considering Aquablation therapy should review all potential risks with their urologist in evaluating whether the treatment may be right for them. For men looking for a safe, effective, and sexual function-sparing BPH therapy, Aquablation therapy is proving to be a durable treatment for urinary symptoms brought on by benign prostatic hyperplasia.

 

References:

  1. Gilling PJ et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022 Feb;29(1):10960-10968.
  2. Bhojani N et al. Aquablation Therapy in Large Prostates (80-150 mL) for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Final WATER II 5-Year Clinical Trial Results. J Urol. 2023 Jul.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988689/
  4. https://consultqd.clevelandclinic.org/aquablation-therapy-offers-alternative-approach-for-benign-prostatic-hyperplasia
  5. https://www.houstonmethodist.org/blog/articles/2022/jun/aquablation-therapy-is-it-the-right-bph-treatment-option-for-you/

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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