If you have benign prostatic hyperplasia (BPH), also known as an enlarged prostate, you may be trying to get up to speed on the new BPH treatments available, including aquablation therapy.

Dr. Ricardo Gonzalez, a urologist at Houston Methodist, helps explain how aquablation therapy works and whether it might be the right BPH treatment option for you.

When should you consider treatments beyond medication for BPH?

Medications can help treat BPH, but Dr. Gonzalez points out that even maximal medication therapy will fail one in three men by five years. Failure, in this sense, means that symptoms will continue to progress despite using medications.

"If we add to such failures the number of men who experience side effects to medications or intolerance of having to be on medical therapy altogether, the risk of medical failure for BPH treatment is actually higher than that," Dr. Gonzalez adds.

Medication therapy may also be too little, too late for people whose symptoms have already progressed to the moderate or severe stage.

The point at which you decide it's time to consider other treatment options for BPH depends on the individual, of course. But what's important to know is that you don't have to let your symptoms continue to get worse and worse.

"People used to wait a long time because they feared the complications of prostate surgery, assuming that every surgical option would result in sexual dysfunction and urinary incontinence," explains Dr. Gonzalez. "With totally robotic surgical approaches like aquablation therapy, that's simply not the case anymore."

What is aquablation therapy?

Aquablation therapy is one of several surgical treatments available to treat BPH.

It's an incision-less procedure that uses an image-guided robotic arm. The arm holds a water jet to very precisely remove excess prostate tissue.

"Since we enter through a natural orifice, the urethra, there are no incisions during this procedure," Dr. Gonzalez explains. "And the use of image-guided robotics means tissue is removed with great precision."

This reduces post-operative pain and speeds up recovery, compared to traditional surgical approaches.

"One of the amazing things about aquablation therapy is that patients experience little to no pain," Dr. Gonzalez adds. "There's some mild discomfort after surgery, at max perhaps a 3 out of 10 on the pain scale — and that number should quickly drop."

Additionally, because the tissue is removed using room-temperature saline water, the blockage can be fixed without harming or burning the prostate tissue that remains. Saline water is biocompatible with the human body.

"Several other surgical prostate therapies destroy excess tissue using heat or harsh substances, both of which can harm the remaining tissue and likely contribute to some of the sexual dysfunction seen after those procedures," explains Dr. Gonzalez.

Aquablation therapy avoids these issues, removing excess tissue without affecting your ability to urinate or engage in sex. The risk of not being able to ejaculate after aquablation is only around 10%, compared to a 30%-100% risk with other approved surgical approaches to treat BPH.

The procedure, performed while the patient is under anesthesia in an operating room, typically takes about 45 minutes, almost half as long as traditional prostatectomy.

How does aquablation therapy compare to other BPH treatment options?

Beyond medications, the two categories of treatments for BPH include:

• Minimally invasive surgical therapies (MISTs), including prostatic urethral lift procedure, water vapor therapy and a temporarily implanted nitinol device
• Surgery, including aquablation, laser vaporization and laser enucleation therapies, as well as transurethral resection of the prostate (TURP) and open prostatectomy
  
  

Because aquablation is performed in an operating room and requires an overnight hospital stay, it's considered surgery.

MISTs, on the other hand, are the procedures that fit in the space between medications and surgeries — they provide more benefit than medications, but they don't require the hospital stay that comes with surgery.

"The MISTs are much quicker office-based procedures, but they provide less benefit than the surgical options like aquablation," says Dr. Gonzalez. "Surgical intervention generally allows us to get more tissue out of the way, providing greater symptom relief."

This means that aquablation therapy may be the better option for you if:

• Your BPH symptoms are moderate to severe
• Your medications are failing
• You can no longer urinate on your own and have to use a catheter
• Your prostate is very enlarged
• You're experiencing other complications of BPH, including kidney failure, infections, bleeding and stones
  
  

On the other hand, if your prostate is only mildly enlarged and you're just looking for some symptom reduction beyond what medications can provide, an office-based MIST might be perfectly suitable for you.

Your urologist can help you understand your symptom severity and effectively weigh your options.

"Essentially, the answer to which type of BPH treatment is right for you lies in the severity of your underlying problem and how much symptom reduction you're hoping to achieve," says Dr. Gonzalez. "But if your medications aren't working, know that a MIST procedure isn't going to be enough."

How long does it take to recover from aquablation therapy?

After aquablation therapy, the majority of men need just one night of hospital monitoring and use of a catheter.

"For most, we then remove it the next morning and you go home catheter-free," says Dr. Gonzalez.

He adds that there should be very little discomfort after the procedure and essentially none within a few days.

The main restriction is to not lift more than 10 pounds in each arm for two weeks.

"Most men feel like they can physically do more than that soon after, but we want to limit strain since it can provoke bleeding at the surgical site," explains Dr. Gonzalez. "So, there's no heavy lifting for two weeks, but, unless your work involves heavy labor, you can go back to work right away."

And there's more good news.

"Aquablation is a remarkably effective procedure," says Dr. Gonzalez. "When we take a look at men five years post-surgery, 95% of them still aren't in need of re-treatment. It's a very durable treatment option for men with BPH with the lowest risk of sexual side effects compared with traditional prostate surgeries."