BPH TREATMENT WITHOUT COMPROMISE.

Since so many men suffer from BPH, there are a wide variety of treatment options—from medication to surgery—that can help provide relief.

The challenge with treatment options for BPH today is that they often force men to compromise in some way. This could mean not responding well to medication, getting only limited relief, a long recovery time, or even issues with sexual function.

We believe that men with BPH shouldn’t have to accept these compromises.

BPH Treatment Options

There are several treatment options for BPH. Every patient is different, so it is important to speak with a doctor to determine which treatment is right for you.

There are generally three categories of treatment:

  1. Watchful waiting
  2. Medication
  3. Surgery

Watchful Waiting

If a patient determines that his symptoms are not bad enough to start treatment, he can choose watchful waiting.

This means that before considering any medical treatment, the doctor and patient wait to see if symptoms get worse, or new symptoms develop. For most men, their prostates will continue to grow and their symptoms will worsen.

A patient should consider visiting a doctor every year to determine if his symptoms are changing.

binoculars

“I waited way too long before I got any help. It was horrible. For years I was literally waking up 5-6 times every night to go to the bathroom.”

Chris D., 55

pills

“I kept thinking that I’d get used to the medicine and that the side effects would go away, but after a month I couldn’t take it any longer and knew I needed to figure something else out.”

Chris D., 55

BPH Medications

Medications are often the first step in treating BPH. They are prescribed by your doctor to address your symptoms by either shrinking (5-alpha reductase inhibitors) or relaxing (alpha blockers) the prostate. In some instances, patients may be prescribed a combination of both medications.

While medications can provide relief for some men, they are often associated with side effects, including, but not limited to, dizziness, headache, fatigue, less libido, erectile dysfunction, and ejaculatory dysfunction.1

For some men, medications may stop working after a while, and they may try a second medication. This second medication may stop working, and they may need to consider an alternative treatment. This roller coaster can be frustrating.

Ultimately, studies show that medications fail in up to 30% of men.1

Medications are a good option for many men. But, many men dislike medications because they force men to compromise between symptom relief and side effects.

Surgery for BPH

Surgery is a more invasive and perhaps longer-lasting treatment for BPH. There are two types of surgical treatments:

Non-Resective Prostate Surgery

In non-resective procedures, prostate tissue is not removed. These procedures generally do not require an overnight stay in a hospital, and may sometimes be done outside of the hospital setting.

However, by not removing the prostate tissue, there is also risk that a patient will need a resective procedure in the future because the prostate will keep growing.2

Resective Prostate Surgery

In resective procedures, some or most of the prostate tissue is removed, so these procedures are generally longer-lasting than non-resective procedures.2

These procedures are generally done in a hospital or surgery center, and patients may stay one or more nights in the hospital.

Types of Prostate Resection Surgery
  • Minimally invasive procedures
    These procedures access the prostate through the urethra, so no incisions are made in the patient’s abdomen.
  • Open or laparoscopic surgery
    These procedures require one or more incisions to be made in the patient’s abdomen to access the prostate.

baseball bat

“I was concerned about how surgery was going to change me physically. Am I going to become less of a man? How is it going to affect my self-confidence?

I know there are tradeoffs, but I needed to weigh everything before making a decision.”

John D., 51
82% OF MEN WITH BPH ARE NOT WILLING TO SACRIFICE SEXUAL FUNCTION FOR SYMPTOM RELIEF WITH SURGERY4
85% OF MEN WITH BPH ARE CONCERNED THAT SURGERY WILL CAUSE INCONTINENCE4
92% OF MEN WITH BPH SAY MAINTAINING ERECTILE FUNCTION AFTER SURGERY IS IMPORTANT4

How to Choose Which BPH Surgical Option is Right For You

There are many different surgical options available. Deciding which surgery to have to treat your BPH is overwhelming and scary. No one likes being under anesthesia or going to the hospital.

You probably know someone—a friend, father, grandfather, uncle—who has had surgery for BPH but had to make a compromise in some way. It’s important to learn about all of your surgical options to determine which surgery is best for you.

Here are some things to consider when choosing which surgical option is best for you and topics to discuss with your doctor.

When it comes to BPH surgery, you should specifically ask your doctor about “irreversible complications” like erectile dysfunction, ejaculatory dysfunction, and incontinence. Irreversible complications are common with most resective procedures.3 There are two reasons:

Limited View of the Prostate

The surgeon’s view of the prostate in resective procedures is limited to a single camera, called a cystoscope, that provides limited visibility of the prostate. This makes it difficult for the surgeon to see the critical parts of the prostate that control erectile function, ejaculatory function, and incontinence. Aquablation therapy is the only procedure that uses a cystoscope in combination with ultrasound imaging to enable the surgeon to see the entire prostate during surgery.

Removing Prostate Tissue

Most resective procedures use only heat to remove prostate tissue; heat may be damaging to the parts of the prostate that control erectile function and ejaculatory function. Aquablation therapy is the only procedure that uses a heat-free waterjet to precisely remove prostate tissue.

All surgical procedures have a risk of complications, and these should be discussed with your doctor.

With any surgery, you’ll want to be confident that the procedure is going according to plan. It is important to know how many procedures your surgeon has performed to understand how skilled they are or what they are doing to minimize human error. With Aquablation therapy, the robotic technology removes prostate tissue in a precise, consistent, and predictable way, thereby minimizing human error.

You’ve suffered long enough, so you want to be sure that your BPH treatment option works—and works long-term. In clinical studies, Aquablation therapy has been shown to provide long-term relief at three years.1

77% OF MEN WITH BPH FEEL THAT SURGERY REQUIRES A TRADEOFF BETWEEN SYMPTOM RELIEF AND SIDE EFFECTS4
1 in 2 MEN WITH BPH DID NOT REALIZE HOW IMPORTANT MAINTAINING EJACULATORY FUNCTION WAS TO THEM BEFORE SURGERY4
96% OF MEN WITH BPH WISHED THEIR DOCTORS WOULD HAVE DISCUSSED AQUABLATION WITH THEM4

Surgical Options for an Enlarged Prostate

There are many different surgical options available and choosing the one that is right for you can be overwhelming. It is important to research and determine which type of procedure is best for your current condition and lifestyle.

Aquablation

Surgical Procedure Type

Resective

How it Works

  • Uses a camera through the urethra plus ultrasound imaging
  • Surgeon creates map of prostate tissue to remove
  • Heat-free waterjet removes prostate tissue

Rates of Irreversible Complications

  • Low rates of irreversible complications
    • 0% rate of erectile dysfunctiona,b
    • 1% rate of incontinencea,b
    • Nearly all men preserve ejaculatory functiona,b
  • Superior safety compared to TURPb
  • Better outcomes in prostates larger than 50 gramsb

Confidence in Procedure

  • Robotically-controlled resection
  • No limit to prostate size
  • Robotics minimizes dependence on surgeon skill

Long-Term Relief

  • Provides long-term relief with low reoperation ratesa,b
  • Better outcomes than TURP in prostates larger than 50 gramsb

Recovery

  • Most patients discharged from the hospital the next day
  • Most patients go home without a catheter
  • Patients may experience mild burning during urination

a. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
b. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079.

TURP

Surgical Procedure Type

Resective

How it Works

  • Uses a camera through the urethra
  • A heated wire cuts out prostate tissue

Rates of Irreversible Complications

  • High rates of irreversible complications
    • 10% rate of erectile dysfunctiona
    • 2% rate of incontinencea
    • 62-75% rate of ejaculatory dysfunctionb,c

Confidence in Procedure

  • Not suitable for every prostate size
  • Manual resection – outcomes dependent on surgeon skill level

Long-Term Relief

  • Symptom relief can last for a long time, and reoperation rates are lowd

Recovery

  • Most patients discharged from the hospital the same or next day
  • Most patients go home without a catheter
  • Patients may experience mild burning during urination

a. Westwood, J, et al. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol. 2018 Nov; 10(11): 327–333.
b. Delay, KJ, et al. Ejaculatory dysfunction in the treatment of lower urinary tract symptoms. Transl Androl Urol. 2016 Aug; 5(4): 450–459.
c. Leong, JY. Minimizing Sexual Dysfunction in BPH Surgery. Curr Sex Health Rep. 2019 Sep; 11(3): 190–200.
d. Urology Care Foundation, The Official Foundation of the American Urological Association. Accessed Dec 2019. https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)

Laser Treatment

Surgical Procedure Type

Resective

How it Works

  • Uses a camera through the urethra
  • A laser is used to remove prostate tissue

Rates of Irreversible Complications

  • High rates of irreversible complications
    • 11-33% rate of incontinencea,b
    • 50-96% rate of ejaculatory dysfunctionc

Confidence in Procedure

  • Manual resection – outcomes dependent on surgeon skill level

Long-Term Relief

  • Symptom relief can last for a long time, and reoperation rates are lowa,b

Recovery

  • Most patients discharged from the hospital the same or next day
  • Most patients go home without a catheter
  • Patients may experience mild burning during urination

a. Bachmann, A, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial–the GOLIATH study. Eur Urol. 2014 May;65(5):931-42
b. Sapetti, J, et al. Urinary incontinence after HOLEP: Incidence, evolution and predictive factors. Prog Urol. 2019 Feb;29(2):101-107
c. Michalak, J, et al. HoLEP: the gold standard for the surgical management of BPH in the 21st century. Am J Clin Exp Urol. 2015; 3(1): 36-42.

Simple Prostatectomy

Surgical Procedure Type

Resective

How it Works

  • An incision is made in the abdomen to access the prostate
  • Inner part of the prostate is removed

Rates of Irreversible Complications

  • High rates of irreversible complications
    • 80-90% rate of ejaculatory dysfunctiona

Confidence in Procedure

  • Manual resection – outcomes dependent on surgeon skill level

Long-Term Relief

  • Symptom relief can last for a long time

Recovery

  • Patients stay in the hospital for an average of 5.4 daysb

a. Khera, M. Simple Prostatectomy. Medscape. 2018. https://emedicine.medscape.com/article/445996-print
b. Pariser, JJ, et al. National trends of simple prostatectomy for benign prostatic hyperplasia with an analysis of risk factors for adverse perioperative outcomes. Urology. 2015. 86(4) 721-726.

Prostatic Urethral Lift

Surgical Procedure Type

Non-resective

How it Works

  • Uses a camera through the urethra
  • Implants inserted to hold prostate tissue out of the way of the urethra

Rates of Irreversible Complications

  • Low rates of irreversible complicationsa

Confidence in Procedure

  • Manual procedure
  • Not suitable for every prostate sizeb

Long-Term Relief

  • Symptom relief is less than with resective techniquesa,c
  • 33% of patients will need additional surgery or will need to go back on medicationc

Recovery

  • Most patients go home same daya
  • Most patients go home with a cathetera
  • Side effects may include pain or burning while urinating or blood in urine

a. Sonksen, J, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015 Oct;68(4):643-52.
b. UroLIFT System UL 400 Instructions for Use. L00136-01 Rev A 03/2019
c. Urology Care Foundation, The Official Foundation of the American Urological Association. Accessed Dec 2019. https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)

Water Vapor

Surgical Procedure Type

Non-resective

How it Works

  • Uses a camera through the urethra
  • Hot water vapor (or steam) is used to kill overgrown prostate tissue

Rates of Irreversible Complications

  • Low rates of irreversible complicationsa,b

Confidence in Procedure

  • Manual procedure
  • Not suitable for every prostate sizec

Long-Term Relief

  • Symptom relief is less than with resective techniquesa

Recovery

  • Most patients go home same daya
  • 90% of men have a catheter for 3.4 daysd
  • Side effects may include pain or burning while urinating or blood in urine

a. Westwood, J, et al. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol. 2018 Nov; 10(11): 327–333.
b. Urology Care Foundation, The Official Foundation of the American Urological Association. Accessed Dec 2019. https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)
c. Rezūm™ Delivery Device Kit for BPH Prescriptive Information. Instructions for Use. URO-592203-AB OCT 2019
d. McVary KT, et al. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2016 May;195(5):1529-1538.

watch

“I watched my dad as he went through this and opted for surgery and he became incontinent as a result. So, naturally, I was really concerned about this happening to me, and this was weighing very heavily on my mind when I started to face my BPH and consider my treatment options.”

Steve S., 73

References
  1. Kaplan, SA. Factors in Predicting Failure with Medical Therapy for BPH. Rev Urol. 2005;7 Suppl 7:S34-9.
  2. Urology Care Foundation, The Official Foundation of the American Urological Association. Accessed Dec 2019. https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)
  3. Gilling, P, et al. Two-Year Outcomes After Aquablation Compared to TURP: Efficacy and Ejaculatory Improvements Sustained. Adv Ther. 2019 Jun;36(6):1326-1336.
  4. Data on file at PROCEPT BioRobotics.

All surgical treatments have inherent and associated side effects. 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. 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. 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.