Urologists at Hackensack University Medical Center have become the first in northern New Jersey to offer an innovative treatment for benign prostatic hyperplasia (BPH) that uses a high-intensity waterjet to destroy (ablate) excess prostate tissue that causes uncomfortable urinary symptoms for many older men. Aquablation® therapy is an option for men whose prostate enlargement cannot be effectively treated using prostate-shrinking medications. Aquablation therapy is performed using the AquaBeam Robotic System, guided by real-time imaging to deliver treatment with extraordinary precision.
BPH is the most common reason men see a urologist. About half of all men aged 51-60 develop BPH, and the incidence rises with each decade of life. It causes symptoms that impair quality of life, such as trouble urinating, feeling like they cannot fully empty the bladder, and needing to urinate frequently — including multiple overnight trips to the bathroom that can impact sleep.
Some 30-50 million men in the United States have BPH, 10-15 million of whom are actively managing their condition with medications (such as Flomax® or Proscar®) or other treatment. In more than one million men each year, BPH medications are not effective enough and patients need surgery. Most urologists counsel their patients to try medication for at least 4 weeks before resorting to surgery.
The most common surgical approaches are transurethral resection of the prostate (TURP), in which the prostate tissue is removed through the urethra, and GreenLight laser surgery, which vaporizes prostate tissue. Both treatments may cause sexual side effects such as retrograde ejaculation, in which semen backs up into the bladder when a man ejaculates; in the case of laser treatment, as many as 90% of patients may experience this side effect. Flomax is also associated with this side effect, while Proscar can reduce sex drive and cause erectile dysfunction and hot flashes.
Aquablation therapy is indicated for any man whose prostate is causing an obstruction, and who cannot achieve relief with medication or does not want to take these drugs. “Aquablation therapy is as effective as these other minimally invasive treatments but with fewer side effects, including only a 10-15% risk of retrograde ejaculation,” explained Ravi Munver, M.D., vice chair of Urology and division director of Minimally Invasive and Robotic Urologic Surgery at Hackensack University Medical Center. “Aquablation is performed using a robotic system with ultrasound guidance. As a result, the procedure can be completed rapidly and with a higher level of precision that is reproducible from surgeon to surgeon. The advantage of real-time ultrasound imaging is that a surgeon can see where the prostate tissue ends, which allows removal of more of the excess tissue. Aquablation therapy is the only heat-free and image-guided waterjet ablation approach that is available to treat BPH.”
Here’s how it works: The patient is asleep under anesthesia. An ultrasound probe is inserted into the patient’s rectum to produce clear images of the prostate. The addition of ultrasound imaging enables the surgeon to map the parts of the prostate to remove and the parts to avoid. The Aquablation scope is inserted into the urethra. When ready to begin, the surgeon presses on a foot pedal and the Aquablation system advances through the prostate, delivering a heat-free waterjet so intense that it can remove the prostate tissue that has been mapped out.
“Depending on the size of the prostate, the resection time may take as little as 5 minutes,” said Michael D. Esposito, M.D., Hackensack University Medical Center. Dr. Esposito explained that the patient stays in the hospital overnight with a urinary catheter and typically goes home as soon as the next day. Patients report feeling a reduction in BPH symptoms right away and are able to go off their BPH medications. “Aquablation achieves years of prostate relief, and we’re thrilled to offer this new option to our patients.”
High-tech treatments such as Aquablation therapy are best suited to centers with expertise and high volumes in the field of robotic surgery. “For years, Hackensack University Medical Center has been a national leader in the use of robotic surgery, especially for urologic procedures, and we have trained many other surgeons in its use,” noted Michael Stifelman, M.D., chair of Urology. “We are proud to be the first in northern New Jersey to offer this innovative treatment to restore comfort and quality of life to men with BPH.”