Aquablation Therapy Expands Treatment Options for Patients With Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH), also known as enlarged prostate, is one of the most common urologic conditions affecting aging men, affecting approximately 50% of men in their 50s and up to 90% of men over age 80. BPH can cause progressive lower urinary tract symptoms (LUTS) that significantly affect sleep, daily activities and overall quality of life.

Expanding Treatment Options for Persistent BPH Symptoms

As prostate tissue enlarges, it can constrict the urethra and contribute to bladder outlet obstruction, resulting in symptoms such as urinary frequency and urgency, nocturia, weak or intermittent stream, straining and incomplete bladder emptying. These symptoms can have broader health implications, including sleep disruption and sexual dysfunction, while frequent nighttime urination may increase the risk of falls and fractures. Persistent bladder outlet obstruction can also affect bladder and kidney function over time.

For patients with an enlarged prostate whose urinary symptoms are not adequately controlled with medication, referral to Moffitt Cancer Center can provide access to additional treatment options, including Aquablation therapy. This minimally invasive treatment uses advanced imaging, robotic technology and a heat-free waterjet to precisely remove obstructive prostate tissue.

Aquablation gives us a precise, robotic minimally invasive option to treat urinary symptoms caused by an enlarged prostate. Because this technology can treat a wide range of prostate sizes, it gives us another option to consider when developing an individualized treatment plan. We can also consider each patient's overall health and medical history to determine whether Aquablation is the right approach for them.

-Marilin Nicholson, MD, Genitourinary Oncology Program

How Aquablation Therapy Works

Aquablation differs from many traditional BPH procedures because prostate tissue is removed using a high-velocity saline waterjet rather than heat. The procedure combines real-time imaging, surgical planning and robotic assistance to allow the surgeon to identify obstructive tissue while accounting for anatomy involved in urinary continence and sexual function.

Before tissue removal begins, the surgeon identifies important anatomy and develops an individualized treatment plan defining the tissue targeted for resection. The robotically controlled, waterjet then removes the designated prostate tissue according to the surgeon-approved plan.

Moffitt uses the next-generation HYDROS Robotic System for Aquablation therapy. The platform incorporates AI-powered treatment planning developed using real-world Aquablation procedures, expert surgeon input and image-recognition software. It is designed to assist surgeons with identifying critical anatomy, developing an individualized treatment plan and facilitating treatment workflow.

The system also integrates next-generation ultrasound and digital cystoscopy, providing simultaneous visualization of prostate anatomy. Robotic assistance then executes the surgeon-approved treatment plan using the heat-free waterjet to resect obstructive tissue while preserving critical anatomy identified during planning. The platform is designed for use across a range of prostate sizes and shapes.

Balancing Symptom Relief With Functional Outcomes

Treatment selection for BPH requires consideration not only of symptom severity and prostate anatomy but also of potential effects on urinary and sexual function.

Aquablation's image-guided planning allows the surgeon to identify structures associated with bladder function, urinary continence and ejaculation before determining the treatment area. Because tissue is removed with a heat-free waterjet, there is no thermal energy applied during resection.

Clinical studies cited in the Aquablation treatment literature have demonstrated significant symptom relief with low rates of irreversible complications across different prostate sizes and anatomies. Treatment decisions should continue to account for individual anatomy, symptoms, comorbidities and patient goals.

Comprehensive Evaluation and Treatment

For patients with BPH, particularly those who also have an elevated prostate cancer risk, an abnormal screening result or an existing prostate cancer diagnosis, access to a comprehensive urologic evaluation can help inform treatment decisions.

Moffitt's urologic experts evaluate the patient's urinary symptoms in the context of their complete prostate health. For select patients with prostate cancer on active surveillance, this provides an opportunity to address bothersome urinary symptoms while considering the patient's ongoing cancer surveillance and treatment strategy.

The availability of advanced technologies such as the HYDROS Robotic System also expands the range of procedural options that can be considered based on each patient's prostate anatomy, symptoms, medical history and goals.

This comprehensive approach allows referring physicians to connect patients with urologic experts who can evaluate both the immediate cause of their urinary symptoms and the broader clinical considerations that may influence treatment.

What Patients Can Expect

Aquablation is performed under general anesthesia at Moffitt McKinley Hospital. A temporary urinary catheter is placed following the procedure.

During early recovery, patients may experience temporary burning with urination, blood or tissue debris in the urine and changes in urinary frequency, urgency or urinary flow. Most symptoms typically resolve within two to four weeks, although bladder-related symptoms such as frequency, urgency and nocturia can take longer to improve.

For patients with persistent BPH symptoms or those considering procedural treatment, referral for evaluation can help determine whether Aquablation or another approach is appropriate based on their anatomy, symptoms and overall prostate health.