Benign prostatic hyperplasia (BPH), or an enlarged prostate, is a common condition affecting the majority of men over 50. While often manageable, BPH can cause persistent symptoms, such as difficulty urinating, frequent nighttime bathroom trips, and bladder discomfort. If untreated, complications like kidney stones, infections, and bladder damage may arise. Treatments range from medications to surgical interventions, and one of the most promising newer techniques is aquablation.
Aquablation is a minimally invasive surgical procedure that removes excess prostate tissue using highly pressurized jets of saline. Guided by real-time ultrasound imaging, doctors precisely target and trim problematic tissues while sparing delicate areas critical to sexual function. This procedure is performed under general anesthesia, ensuring a painless experience for the patient.
Following aquablation, patients typically require a catheter for around 24 hours to manage temporary swelling in the urethra. Despite this short post-operative inconvenience, many men report a significant improvement in their urinary symptoms and overall quality of life. One major advantage of aquablation compared to traditional BPH treatments is its ability to preserve normal ejaculation, a concern for many patients undergoing prostate surgery.
In a recently published study, researchers analyzed long-term outcomes from two clinical trials the WATER and WATER II studies. These trials tracked 217 men with varying prostate sizes over five years. When enrolled, participants reported average International Prostate Symptom Scores (IPSS) of 22.9 and 23.3, indicating severe symptoms. After five years, their average scores dropped to 7.0 and 6.8, representing mild symptoms.
Additionally, the need for ongoing BPH medication was nearly eliminated, with only 1% of participants still requiring treatment. Re-treatment rates were also low, with fewer than 5% of patients needing another surgical procedure. The average hospital stay for aquablation patients was brief around 1.4 to 1.6 days further emphasizing its convenience and effectiveness.
A comparative trial, WATER III, is currently evaluating aquablation against laser-based prostate enucleation, a more established BPH surgery. Early data indicate that both techniques yield similar symptom relief. However, prostate enucleation carries a significant risk of ejaculatory dysfunction due to damage near the bladder neck, a common side effect that was notably absent in the aquablation group.
While aquablation offers several advantages, it is not without potential downsides. The procedure does not use heat to cauterize tissues, which increases the likelihood of post-operative bleeding. Patients may notice blood in their urine for up to six weeks after surgery. Additionally, aquablation may not be suitable for men on blood-thinning medications unless they can temporarily discontinue use during recovery.
“Aquablation is an excellent choice for men with medium to large prostates seeking a durable solution without sexual side effects,” says Dr. Heidi Rayala, an assistant professor of urology at Harvard Medical School. However, she emphasizes the importance of individual evaluations to determine whether the procedure is appropriate.
Dr. Marc Garnick, a leading expert at Harvard Medical School, agrees that the results from aquablation are promising but advises caution. “Further evidence involving larger patient groups and longer follow-ups will be crucial to establishing this method as a go-to treatment option,” he notes.
Aquablation represents a significant step forward in the management of benign prostatic hyperplasia. By combining advanced technology with a patient-centered approach, this innovative procedure offers long-lasting symptom relief while preserving sexual function a balance many men have long sought in prostate health care. For men living with BPH, aquablation provides not just a treatment but a pathway to improved quality of life.
