The Science Behind Aquablation Therapy
How Waterjet Resection Works

February 7, 2024
Aquablation therapy by PROCEPT BioRobotics is a novel minimally invasive BPH treatment that employs the power of water conveyed through robotic precision to safely remove (resect) obstructive tissue from an enlarged prostate of any size that is exhibiting bothersome lower urinary tract symptoms (LUTS) brought on by benign prostatic hyperplasia or BPH. The prostate, originally about the size and shape of a walnut when a man is young, is an important component of the male reproductive system. It produces a watery, milky-colored liquid that contains many enzymes, including one called prostate-specific antigen (PSA), which helps nourish sperm and makes semen thinner, thus aiding in the transport of sperm as they make their way out of the penis during ejaculation. The initial prostatic growth phases allow for a successful puberty and prime reproductive years as a young man grows from a teenager into his early and mid-20s. Unfortunately, for most men, after a pause in its growth cycle, prostate tissue continues growing for the rest of a man’s life. This next growth period can become problematic if the prostate gland enlarges to the point where it encroaches upon and begins pinching the urethra, bladder, or both. When this uncontrolled prostatic growth gets to the point where it is diagnosed as BPH or prostatic hyperplasia and is causing life-altering LUTS, it should be addressed. It can be noted that the most common reason men visit their urologist is to address their BPH symptoms.5 There are many lifestyle adaptations or changes that a man can make to address minor BPH symptoms and still lead a mostly normal life. This is known as watchful waiting where annoying urinary symptoms caused by benign prostatic hyperplasia are monitored and adjusted to, but no medical intervention is sought. When BPH symptoms begin to become more bothersome, many men will take next-level steps and seek out appropriate BPH medication or surgery to address their symptoms and achieve their treatment objectives. Whether the goal is to relax the muscles of the prostate and bladder neck to lessen symptoms (alpha-blockers) or to actively try and shrink the prostate (5-alpha reductase inhibitors (5-ARIs) and surgery), there are many BPH medications and numerous surgical options from which to choose. Aquablation therapy is one of the more advanced prostatic hyperplasia treatments that is unique in its approach to resecting obstructive prostate tissue and delivering lasting relief for an enlarged prostate and BPH symptoms.6 Even though Aquablation therapy works well for all prostate sizes and shapes, a man with a large prostate that doesn’t qualify for other minimally invasive BPH procedures which may have prostate size limits, may find the Aquablation procedure a good fit.

The Science Behind Aquablation Therapy

Aquablation therapy is an advanced, one-of-a-kind, endoscopic, and resective BPH therapy that utilizes the power of water to remove obstructive prostatic tissue and safely treat LUTS brought on by benign prostatic hyperplasia. Since the waterjet resective phase of Aquablation therapy is heat and incision-free, it doesn’t affect erectile function, 99% of men won’t experience incontinence, and 90% of men preserve ejaculatory function when undergoing Aquablation therapy.1,2,3 Another advantage that Aquablation therapy affords men with prostatic hyperplasia is that it is a good option for men with any size or shaped prostate. Some BPH procedures can only work on small to medium-sized prostates of 80 grams or less. The science behind Aquablation therapy is cutting edge, literally. In harnessing the unique characteristics and abilities of a waterjet to resect tissue while keeping surrounding tissue safe from any thermal damage, Aquablation is successful in providing both long-term BPH symptom relief and preservation of continence and sexual function.1,2 Most side effects from Aquablation therapy are typically very minimal and short-lived. Read about the complete list of potential side-effects here.

Aquablation Software

Aquablation therapy’s integrated, advanced planning software provides the computational power and graphic interface that allows for the display of vital procedural information, buttons, mapping, and images produced by both a cystoscope and ultrasound imaging. This provides the surgeon with the ability to define the treatment plan, together with multidimensional views, to effectively complete the procedure.

AquaBeam Robotic Precision

Surgeons are very precise and meticulous with the procedures they perform. However, both surgeons and patients alike can appreciate the predictable precision that a multi-dimensional, image-guided surgical robotic system can provide to ensure that the Aquablation procedure is as successful as possible. Aquablation therapy employs this robotic precision with its AquaBeam Robotic System to precisely follow the patient-specific treatment plan defined for the waterjet resection (surgical removal) of problematic prostate tissue.

Cystoscope Camera and Ultrasound

Other BPH procedures are limited to a two-dimensional cystoscope camera view of the therapy as it is being performed. Aquablation therapy’s science and software allow for the utilization of both a cystoscope camera and ultrasound imaging to provide a multidimensional view of the prostate to enable the surgeon to better map the exact areas to be resected without causing damage to surrounding critical structures.

Waterjet Resection

Robotically controlled waterjet technology is what makes Aquablation therapy unique in the field of BPH procedures. Utilizing a high-velocity, heat-free waterjet to resect and remove problematic prostate tissue, the AquaBeam Robotic System offers patients the precision of robotics coupled with the expertise and guidance of a trained surgeon.

How Aquablation Waterjet Resection Works

Aquablation therapy, with its unique waterjet resection of prostatic tissue, is performed in the operating room utilizing the AquaBeam Surgical Robotic System as the patient is under either spinal or general anesthesia. Personalized treatment planning and mapping, together with real-time multidimensional imaging and robotic-assisted precision, allows for predictability and reproducibility in delivering a heat-free, high-velocity waterjet resection and removal of obstructive prostate tissue.

Prostate Imaging

Unique, real-time, and multidimensional imaging is provided by both the camera-assisted cystoscope and ultrasound which allows for viewing of the prostate from multiple angles. These images combine with Aquablation therapy’s advanced planning software to create the best possible imaging to enable the surgeon to pinpoint areas to both remove and preserve.

Prostate Surgery Map

Since each prostate varies in size and shape, a customized surgical map of the area to be resected via waterjet ablation is designed by the surgeon, based on each patient’s unique anatomy and objectives. Utilizing the AquaBeam Robotic System software, this proactive mapping feature ensures maximum heat-free prostate tissue resection while preserving sensitive structures important for continence and sexual function.

Prostate Tissue Removal

With the surgical map and procedural objectives finalized and in place, a heat-free, robotically-controlled waterjet methodically sprays a jet of water to resect problematic portions of the prostate. The device resects the mapped-out prostatic tissue via a high-velocity waterjet that resects the obstructive prostate tissue that caused the problematic BPH symptoms. This robotic precision minimizes human error, avoids sensitive structures, and provides a precise, consistent, and predictable outcome.
In Conclusion The science behind Aquablation therapy is a testament to how far medical technology has come in the effective treatment of benign prostatic hyperplasia over the past few decades. For nearly 100 years, transurethral resection of the prostate (TURP) has been the gold standard for treating LUTS brought on by BPH. Now, Aquablation therapy and other novel BPH therapies are providing alternatives to men who don’t want to undergo TURP and its potential higher rates of long-term side effects such as retrograde ejaculation, urinary incontinence, and erectile dysfunction.4 It is important for men diagnosed with moderate to severe BPH and exhibiting problematic LUTS to get treated, because “symptoms of BPH often cause significant quality of life issues, and if left untreated, BPH can cause health problems, including irreversible bladder or kidney damage, bladder stones, and incontinence (loss of bladder control).”5 With its one-of-a-kind, heat-free, robotically-controlled waterjet resection of the prostate to produce a long-lasting and highly effective solution to LUTS brought on by BPH, Aquablation has become a safe and effective option to traditional BPH surgery for men with any size or shaped prostate who want substantial BPH symptom relief, coupled with minimal side effects. References:
  1. Gilling PJ et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022 Feb;29(1):10960-10968.
  2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
  3. Data on file at PROCEPT BioRobotics.
  6. Gilling P. et al. Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial. Can J Urol. 2020 Feb;27(1):10072-10079

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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