Benign Prostatic Hyperplasia (BPH) is a common condition affecting many aging men, causing bothersome lower urinary tract symptoms (LUTS). When medication fails, surgical intervention is often necessary to alleviate the obstruction caused by the enlarged prostate. Aquablation therapy is a modern, minimally invasive treatment option for BPH, utilizing advanced technology to address the enlarged tissue. This precise procedure aims to restore normal urinary function, reduce nighttime waking, and provide long-lasting symptom relief.
Scope of Tissue Removal
Aquablation is a resective procedure that does not remove the entire prostate gland. It focuses solely on the hypertrophic tissue causing symptoms, unlike a radical prostatectomy, which is total organ removal typically reserved for cancer treatment. Aquablation specifically targets the obstructive adenoma—the enlarged inner gland, or transition zone, of the prostate. This adenoma presses on the urethra, leading to difficulty with urination and urine storage.
The procedure creates a wide, open channel through the prostate to restore urinary flow. This selective removal of the inner, obstructive tissue provides functional relief from BPH symptoms. By focusing on the adenoma, the treatment maximizes symptom improvement while intentionally leaving the outer regions of the prostate intact.
Precision Through Mechanism of Action
The precision of tissue removal in Aquablation is achieved through a combination of real-time imaging and robotic execution. The system integrates a standard camera (cystoscope) with transrectal ultrasound imaging, giving the surgeon a comprehensive view of the entire prostate. The surgeon uses this enhanced visualization to create a customized surgical map, outlining exactly which tissue should be removed and which critical structures must be avoided.
Once the treatment plan is finalized, a robotic guidance system executes the removal phase. The system uses a high-velocity, heat-free water jet (hydro-ablation) to remove the pre-mapped tissue. This robotic control minimizes human error and ensures the tissue is resected precisely according to the surgeon’s plan. The water-jet resection process is fast, often taking less than ten minutes, which reduces the patient’s time under anesthesia.
Anatomical Structures Retained
Since the entire prostate is not removed, Aquablation is designed to retain several important anatomical structures. The procedure spares the prostatic capsule, the thin, fibrous outer layer of the prostate gland. It also leaves the peripheral zone largely untouched, as this outer area is not typically involved in the obstructive growth of BPH.
Retaining these structures is a deliberate strategy to preserve quality-of-life functions. The external sphincter muscle, which controls urinary continence, is carefully protected during the mapping phase. The ejaculatory ducts and the verumontanum are also preserved to maintain sexual function. This preservation leads to very low rates of new-onset urinary incontinence and a high rate of preserved antegrade ejaculation compared to other surgical options. The precise, cold resection avoids thermal injury to sensitive surrounding nerves and muscular structures.