Aquablation therapy at Oxford, The Manor Hospital

What is Aquablation therapy?

Aquablation therapy is a minimally invasive surgical procedure used to treat benign prostatic hyperplasia (BPH), which is the non-cancerous enlargement of the prostate gland. As the prostate grows, it can narrow the urethra or apply pressure on the bladder, resulting in urinary issues such as difficulty urinating or a weak urine stream.

Aquablation therapy uses a heat-free waterjet to remove excess prostate tissue, providing relief from the symptoms caused by benign prostatic hyperplasia (BPH).

Is Aquablation therapy right for me?

Aquablation therapy may be a good option if:

• You have moderate to severe benign prostatic hyperplasia (BPH) symptoms
• Alternative medications to treat BPH symptoms have not worked
• You prefer a treatment that has a lower risk of side effects and quicker recovery time compared to traditional methods like transurethral resection of the prostate (TURP).

Your doctor may recommend Aquablation therapy after reviewing your medical history, results from diagnostics tests such as ultrasound, symptoms and the size of your prostate.

What are the benefits of Aquablation therapy?

There are several benefits of Aquablation therapy, including:

• Minimally invasive: Aquablation therapy is performed through the urethra with no incisions, making it less invasive than traditional surgery.
• Quicker recovery time: As Aquablation therapy is a less invasive procedure, you can expect a shorter hospital stay and a faster recovery time compared to traditional prostate surgeries.
• Low rate of complications such as bleeding, infection, incontinence, ejaculatory dysfunction or erectile dysfunction.
• Precision: Live imaging during the procedure allows your surgeon to see the entire prostate and remove excess prostate tissue with high precision.

How to prepare for Aquablation therapy

Your doctor will give you specific instructions on how to get ready for your Aquablation procedure, and it's important to follow them closely.

• Medical review and tests: Before your procedure, your doctor will go over your medical history and may ask you to complete some tests, such as a urinalysis, ultrasound, and blood work.

Medications: Tell your doctor about any medications you're taking, including prescription drugs and supplements. You may need to stop certain medications, like blood thinners or anti-inflammatory drugs, to lower the risk of complications.

• Fasting: You’ll be given instructions on when to stop eating and drinking before the surgery.
• Smoking: If you smoke, you may be asked to quit smoking before the surgery, as it can increase the risk of wound infections and slow down healing.
• Post-surgery arrangements: Since Aquablation therapy is done under general anaesthesia, you won’t be able to drive after the procedure. Be sure to arrange for someone to pick you up and take you home.

What happens during Aquablation therapy?

Aquablation therapy is carried out under spinal or general anaesthetic, depending on what your anaesthetist and surgeon decide. The procedure is carried out in two stages:

Step 1: Creating a surgical plan
Your surgeon will guide a cystoscope (a long, thin instrument with a camera at one end) through the urethra to access the prostate. An ultrasound device will also be placed into the rectum.

The cystoscope and ultrasound will allow your surgeon to see the entire prostate and create a detailed map of the tissue that needs to be removed.

Step 2: Removing the tissue
After mapping out the treatment area, a robotically controlled, heat-free waterjet r is used to remove the excess prostate tissue. Throughout the procedure, your surgeon uses the cystoscope and ultrasound to see the prostate in real-time, ensuring greater accuracy and control during tissue removal.

After the procedure, a catheter may be placed in your bladder to help drain urine as you recover.

Recovering from Aaquablation therapy

You may need to stay in the hospital for one or two days after surgery, depending on how well you recover. It is normal to feel some mild pain and discomfort, along with some temporary side effects.

Common side effects include:

• A temporary burning sensation during urination
• Blood or tissue debris in the urine, which may last for a few weeks after surgery
• Urinary issues such as a weak stream, hesitation, or intermittent flow
• Increased frequency, urgency, or nighttime urination (bladder-related symptoms), which may take longer to resolve, sometimes several months

Many people see improvements in urinary symptoms within 1-2 weeks and can return to normal activities within a few days. However, strenuous activities, heavy lifting, and sexual activity should be avoided for several weeks.

Your doctor will give you instructions for recovering at home, which you should follow.

Are there alternatives to Aquablation therapy?

There are several alternatives to Aquablation therapy for treating benign prostatic hyperplasia (BPH) such as:

• Transurethral Resection of the Prostate (TURP): A common surgical procedure where excess prostate tissue is removed through the urethra using an electrical loop.
• Holmium Laser Enucleation of the Prostate (HoLEP): Uses a laser to remove prostate tissue and is suitable for larger prostates.
• Prostatic Urethral Lift (UroLift): Small implants are inserted to hold the enlarged prostate away from the urethra, allowing urine to flow more easily.
• Rezūm water vapour therapy: Minimally invasive procedure using steam to destroy excess prostate tissue.
• Medication: Medications like alpha blockers can help relax the muscles around the bladder, making it easier to urinate. 5-alpha reductase inhibitors can shrink the size of the prostate by blocking dihydrotestosterone (DHT), a male hormone that causes the prostate to grow.