Prostate Problems and Solutions

Prostate Problems and Solutions

Aquablation offers the newest response to BPH


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Fact checked by Shannon Sparks


About a year ago, 68-year-old Chicago native and Las Vegas resident Ellis Harris was struggling with severe benign prostatic hyperplasia (BPH), a condition where the prostate is enlarged but not cancerous. A normal-sized prostate is about 25 grams, but Harris’ was well beyond that, tipping the scales at 120 grams. 

The prostate gland normally begins to grow around age 30, which can cause urine leakage and some erectile issues. Harris’ prostate went into hyperdrive.

“Your body is always changing, and it’s all in harmony,” Harris says. “Everything has to be in balance. Life is going along until one day you realize you’re going to the bathroom four times at night.”

Untreated prostate enlargement leads to urinary symptoms such as:

• Frequent urinary urges

• Slow stream

• Sensation of incomplete emptying

• Night time urination

• Urine leak or retention

Eventually, Harris reached a point where he could no longer urinate and had to wear a catheter, which got infected. He’d tried two previous procedures to fix the problem, but nothing worked. He was at the end of his rope.

“When you cannot urinate, there is nothing more painful in life,” he says. 

“I wanted to die. And I didn’t want to live with a catheter.”

Harris persisted. Searching for treatment options, he stumbled across aquablation — a procedure that first received Food and Drug Administration (FDA) approval in 2017.

“The success rate was really high,” he says of the data he found. He set up an appointment with Endeavor Health to have the procedure.

An answer for all? Not quite

BPH affects about half of men over age 50 in the U.S. Certain common therapies — holding the prostate open, shaving the prostate down with a laser, or cauterizing it — are successful in relieving the symptoms of enlarged prostate; however, they have a high risk of retrograde ejaculation (where ejaculatory fluid enters the bladder instead of exiting through the penis) and a small risk of incontinence.

“A lot of therapies out there have utilized either a clip to pin open the obstructing prostate tissue or a basket to keep the prostate channel open,” says Brian Helfand, MD, Endeavor Health’s chief of urology and clinical professor at the University of Chicago Medicine. “They have preserved sexual function, but they do not offer the same degree of symptom improvement or bother from urinary symptoms. Similarly, many historic procedures that shave the inner part of the prostate down to open the channel caused sexual dysfunction. 

So you lose, you lose.”

Aquablation does not cause those issues. The automated heat-free robotic therapy relies on ultrasound imaging showing multiple dimensions of the person’s prostate. It allows the procedure to be completely tailored to each person’s unique anatomy, keeping the ejaculatory ducts and urinary channel intact. Once the prostate is mapped with imaging, the urologist drafts the treatment area and programs it into the computerized system. The robot then uses a water jet to remove the prostate tissue necessary to resolve the urinary issue.

S. Adam Ramin, MD, a urologist, urologic surgeon, and medical director of Urology Cancer Specialists in Los Angeles, notes however, that aquablation — though very successful — isn’t a fit for every patient.

“This procedure is usually done for prostates that are below 80 grams,” he says. “Treatment of larger prostates may lead to higher risk of bleeding. However, many experienced urologists will treat up to 120 gram prostates using this technique.”

He notes that men with certain prostate shapes, such as those with a large middle portion that has grown into the bladder, should look into other treatment options.

Renewed hope

That being said, aquablation is quickly becoming the gold standard of prostate treatments. Helfand estimates that in Endeavor Health’s Highland Park Hospital, urologists perform six to 10 of these procedures daily. And while the retreatment rate of other prostate procedures is between 4% and 7% every year, with aquablation, it’s less than 1%.

“Another way to think about it is that in a 10-year period afterwards, 90-plus percent of patients [likely] won’t need any additional interventions or treatments,” Helfand says.

Typically minimal, side effects include a small risk of retrograde ejaculation  and a potential risk of postoperative bleeding, which surgeons are fully equipped to handle. Ultimately, the healing process with aquablation is faster and easier than with other treatments.

And patients like Harris are willing to take those small risks in order to change their lives for the better. Now, after his aquablation therapy, Harris says he feels completely better.

“The big thing is being able to still have your manhood and being able to get an erection,” he says. His bathroom trips have improved, too. “I’m urinating like a 20-year-old now. I’m not getting up three or four times during the night to use the bathroom. My bladder is emptying.”

Harris encourages others to look into aquablation, no matter how embarrassed or afraid they might feel.

“Most men are afraid of being impotent during the standard procedure,” he says. “But aquablation removes that fear because they cut around the nerves. And then, you still feel like a man.”

Originally published in the Spring/Summer 2024 print issue.