Men living with an enlarged prostate have a new, minimally invasive treatment option: Aquablation.
“Aquablation helps relieve the symptoms of benign prostatic hyperplasia (BPH) with a much lower chance of procedure-related sexual side effects, as compared to other available surgical treatment options,” said Dr. Michael B. Gross, a urologist on the medical staff of Texas Health Center for Diagnostics and Surgery (THCDS) in Plano, Texas. “It also allows surgeons to operate on patients with very large prostates with more precision, which typically results in less bleeding and much less time in surgery.” 
Aquablation offers several advantages over traditional surgical options. By using a multi-dimensional view of the prostate along with a jet of room temperature saline water, delivered with robotic technology, the surgeon can remove the prostate tissue while maintaining low rates of irreversible complications.
Treating BPH
BPH — also called prostate gland enlargement — is a common condition that affects many men as they get older. In the U.S., about 70% of men 60–69 years of age and 80% of those 70 years of age or older are affected by BPH.
When a prostate grows larger than normal, it narrows the urethra, making it difficult to fully empty the bladder, and puts pressure on the bladder, creating the sensation of an urgent need to urinate. If left untreated, BPH may cause other bladder, urinary tract or kidney problems to develop. The first line of treatment for BPH is medication. If that fails to provide relief, surgery is considered.
Until recently, the typical treatment for BPH was a procedure called transurethral resection of the prostate, or TURP. In this procedure, an instrument was inserted through the urethra (the tube that carries urine from the bladder). With the scope, the surgeon trimmed away excess prostate tissue blocking urine flow using electrocautery. Potential side effects of this traditional BPH surgery included incontinence, erectile dysfunction and ejaculatory dysfunction.
“With Aquablation, the surgeon operates an instrument that goes through the urethra, as well as a transrectal ultrasound probe that provides an image of the prostate,” Dr. Gross said. “Using an ultrasound screen, the surgeon can draw out exactly the area to remove. It’s very precise, because we can plot out exactly what tissue we want to remove.”
Is Aquablation Better than TURP?
TURP is effective for symptom relief but carries a higher risk for side effects. The prostate is located underneath the bladder and wraps around the urethra, in proximity to other important body parts, including the ejaculatory ducts (which emit semen during sexual intercourse) and the sphincter muscles (which control elimination). The prostate gland plays a key role in sexual function. In a significant number of cases, patients undergoing TURP experienced erectile or ejaculatory dysfunction or incontinence.
Aquablation enables the surgeon to navigate more precisely and thus, avoid damaging nearby organs such as the ejaculatory ducts or sphincter muscles. Studies show that Aquablation is equally effective in providing lasting relief for BPH symptoms with a much lower incidence of procedure related side effects.
Are there any risks associated with Aquablation?
All surgical procedures involve some risk. With Aquablation, the most common side effects are temporary and mild. Symptoms that are transient may include mild pain, bleeding or strain while peeing, discomfort in the pelvis, inability to empty the bladder, 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.
“Compared to traditional surgical options, complications like incontinence are very rare, and the incidence of ejaculatory dysfunction is much lower,” Dr. Gross said.
Dr. Gross has a lot of confidence in the Aquablation procedure – not only for his patients but also for himself. He underwent Aquablation to treat his own case of BPH.
“I’ve been a urologist for almost 30 years,” he said. “I specialize in BPH, and knowing everything I do, I chose this procedure for myself.”
What makes someone a good candidate for Aquablation?
Aquablation is especially advantageous for patients with very large prostate glands.
“In most cases, an enlarged prostate is about 50-100 grams of tissue, but we do see a number of patients with much larger prostates, measuring 150 to 350 grams,” said Dr. Gross. “In those cases, TURP isn’t an option because the procedure would take hours and would involve a lot of bleeding.”
The traditional surgical option for very large prostates has been open prostatectomy, which involves incisions made through the abdomen. With Aquablation, patients now have a minimally invasive option.
“One of the big advantages of Aquablation is that we can treat a very large prostate that otherwise would require invasive surgery,” said Dr. Gross. “With Aquablation, the procedure typically only requires a few additional minutes for a patient with a larger prostate.”
How long is the surgery and recovery time for Aquablation?
During the procedure, the patient is under general anesthesia. The patient typically spends about an hour in the operating room, although the time for surgery itself is about only 4-8 minutes. After the surgery, patients will have a catheter overnight. Once the catheter is removed, the patient can urinate on his own but should expect to experience frequency and urgency with urination for the first few days. Most patients can return to work after a week, as Dr. Gross did. For those with very strenuous occupations, two weeks of recovery time might be advised.
Is Aquablation covered by insurance?
Yes, Medicare coverage does include Aquablation. Since December of 2020, Aquablation has been covered for all Medicare patients in the United States who meet the medical criteria for the procedure.
THCDS Services
Texas Health Center for Diagnostics and Surgery in Plano, Texas is proud to offer Aquablation performed with the AquaBeam Robotic System developed by PROCEPT BioRobotics. Aquablation is one of many urologic procedures offered at THCDS. We offer advanced treatments for urologic diseases and conditions, including prostate issues, renal (kidney) surgery, urinary issues and bladder disorders. Patients should follow these basic guidelines to prepare for surgery.
For many men, Aquablation is a great surgical option to get their lives back and feel like themselves again. Call us today to schedule a consultation with a urologist or surgeon.
