What is Aquablation Therapy?
Aquablation using the Aquabeam system (PROCEPT BioRobotics) combines the precision of autonomous robotic execution in delivering high velocity waterjets via a telescopic handpiece with accurate anatomical prostatic mapping using real time transrectal ultrasound imaging.
Under general anaesthesia, initially an ultrasound probe is placed in the rectum to gain images of the prostate. Then a robotic handpiece device with a telescope in it is guided down the waterpipe into the bladder. After registering the handpiece to the real time ultrasound images, the procedure is carefully planned/tailored to map out the prostate anatomy with important landmarks using the software.
Aquablation is then performed by the Aquabeam system, delivering a very fine, very high pressure water jet to ‘wash out’ prostate tissue much like a windscreen wiper, following the plan mapped out by the surgeon. This aims to create a wide defect or hole through the prostate with this water jet without any use of thermal heat. The handpiece is removed, any clot and tissue washed out and a catheter (a tube with 3 channels) is placed under ultrasound control, down the water pipe, through the prostate and into the bladder.
The catheter balloon is inflated and positioned, on imaging, to press onto the bladder neck and prostate and held in position with an external continuous tensioning device. Water irrigation is then flowed through one catheter channel and out through another, washing any blood out to ensure no clots form. The external catheter tensioning device is removed a few hours after surgery and the catheter is taken out either the next day or two.
What are the alternatives to Aquablation Therapy?
• Conservative treatment – restricting your fluid or caffeine intake to improve your urinary symptoms and help you avoid surgery.
• Drug treatment – using either finasteride (to shrink your prostate) or drugs which relax the muscles in the prostate (e.g. tamsulosin) to improve urine flow.
• Transurethral resection of the prostate (TURP) – removing the central, obstructing part of your prostate with electric current, using a telescope passed along your urethra.
• Holmium laser enucleation of the prostate (HoLEP) – removing all the obstructing prostate tissue with a laser, using a telescope passed along your urethra.
• Photo-selective vapourisation of the prostate (“green light” laser prostatectomy) – using a different type of laser to vapourise (burn away) the obstructing prostate tissue, using a telescope passed along your urethra.
• Other minimally invasive surgical procedures that aim to improve symptoms but without removing tissue include Urolift, Rezum, iTIND and Prostatic Artery Embolisation.
Important points
• Aquablation involves high velocity waterjet ablation of prostate tissue to improve the flow of urine.
• The high pressure waterjet saline stream is delivered via a robotic handpiece inserted into your urethra (waterpipe) through a telescope.
• The accurate tailored waterjet ablation of obstructing prostate is achieved through combined real time transrectal ultrasound mapping and telescopic robotic handpiece waterjet delivery.
• A bladder catheter together with or without a continuous tensioning device (attached to the catheter) will be used after the operation to wash out blood clots.
• The most common after effects are temporary bleeding, burning, urinary frequency and urinary retention. Loss of semen emission.
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The London Clinic
145 Harley Street, London
W1G 6BJ
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