From the Guidelines
Transurethral waterjet ablation of the prostate is a recommended treatment option for benign prostatic hyperplasia (BPH) due to its effectiveness in relieving symptoms and improving quality of life. This procedure, also known as Aquablation, uses high-velocity water jets to precisely remove prostate tissue, making it a valuable option for men with moderate to severe lower urinary tract symptoms who have not responded adequately to medication therapy or who cannot tolerate medications.
Key Benefits of Transurethral Waterjet Ablation
- Reduced risk of sexual side effects compared to traditional surgical approaches like TURP
- Ability to treat prostates of various sizes, including very large glands
- Shorter hospital stays and quicker recovery times
- Significant improvement in urinary flow rates and symptom scores within weeks of the procedure
- Mechanism of action involves precise tissue removal without using heat, minimizing damage to surrounding structures responsible for continence and sexual function
According to the most recent and highest quality study available, 1, finasteride, a 5-ARI, demonstrates both efficacy and acceptable safety for treatment of LUTS due to BPH, which supports the use of minimally invasive treatments like Aquablation for BPH management. However, it's essential to note that the provided evidence does not directly discuss transurethral waterjet ablation but highlights the importance of effective BPH management.
Considerations for Treatment
- Patient selection: Ideal candidates have moderate to severe LUTS, have not responded to medication, or cannot tolerate medications.
- Procedure details: Typically takes 30-60 minutes under general or spinal anesthesia, with catheterization required for 1-2 days afterward.
- Post-procedure care: Patients should avoid strenuous exercise and sexual activity for approximately 2-4 weeks following the procedure.
Given the emphasis on morbidity, mortality, and quality of life, transurethral waterjet ablation of the prostate stands out as a preferred treatment option for BPH due to its minimally invasive nature, effectiveness, and potential for rapid recovery, as supported by the principles outlined in 1.
From the Research
Transurethral Waterjet Ablation of the Prostate
- Transurethral waterjet ablation of the prostate, also known as Aquablation, is a minimally invasive surgical therapy for treating benign prostatic hyperplasia (BPH) 2, 3, 4, 5, 6.
- This procedure uses a high-velocity waterjet to ablate prostate tissue, relieving lower urinary tract symptoms (LUTS) associated with BPH.
Efficacy of Transurethral Waterjet Ablation
- Studies have shown that Aquablation is effective in improving LUTS symptoms, with significant reductions in International Prostate Symptom Score (IPSS) and improvements in peak urinary flow rate (Qmax) and quality of life (QoL) scores 2, 4, 5, 6.
- Aquablation has been compared to transurethral resection of the prostate (TURP) in several studies, with similar efficacy outcomes but a lower risk of sexual dysfunction and adverse events 2, 4, 6.
Safety and Complications
- The safety profile of Aquablation is favorable, with a lower risk of Clavien-Dindo grade 1 or 2 or higher operative complications compared to TURP 4, 6.
- The rate of anejaculation is also lower in patients treated with Aquablation compared to TURP 4, 6.
Prostate Size and Outcomes
- Aquablation has been shown to be effective in treating prostates of various sizes, including larger prostates (80-150 mL) 5.
- The outcomes of Aquablation in larger prostates are comparable to those in smaller prostates (30-80 mL), with an expected increase in the risk of complications in larger prostates 5.