What is Aquablation?

•           Aquablation therapy is a robotic, image-guided procedure that uses a high-pressure, heat-free water jet to remove excess prostate tissue, rather than using heat, laser, or cutting tools. Aquablation® US+3Johns Hopkins Medicine+3Southland Urology+3

•           The system integrates real-time imaging (ultrasound plus standard cystoscopic camera views) to map the prostate and plan exactly which tissue to remove and which to spare. Southland Urology+3Johns Hopkins Medicine+3PMC+3

•           Because it’s heat-free (i.e. the tissue removal is by water jet rather than thermal energy), one of its proposed advantages is reduced risk of heat damage to adjacent structures (which might otherwise affect sexual or urinary function). South County Health+3PMC+3Johns Hopkins Medicine+3

Use at St. Joseph’s (Orange County)

•           St. Joseph Hospital in Orange (California) lists Aquablation as one of its urology services. Saint Joseph’s Medical Center

•           The first Aquablation procedure at St. Joseph Hospital was performed by Dr. Matthew Greenberger.ocurology.com+1

•           Dr. Greenberger is described as the first urologist at St. Joseph Hospital in Orange to offer this technique. Aquablation® US

How the Procedure Works & Clinical Details

Here is a more detailed breakdown of the procedure, risks, indications, and evidence:

Procedure Steps & Logistics

1.       Preoperative imaging / mapping

◦        Under anesthesia, a cystoscope (camera) is placed via the urethra into the prostate region.

◦        Simultaneously, intraoperative ultrasound imaging is used to visualize prostate shape and boundaries.

◦        A customized surgical “map” is made, identifying which portions of the prostate to resect and which to avoid (especially zones associated with continence, sexual function, etc.). South County Health+3Johns Hopkins Medicine+3PMC+3

2.       Tissue removal via water jet

◦        A robotically guided, high-pressure sterile saline (water) jet is used to ablate/remove the planned prostate tissue (without heat). Wikipedia+4Johns Hopkins Medicine+4PMC+4

◦        The robot and imaging systems help control depth, contour, and avoid inadvertent damage to critical adjacent structures. PMC+2South County Health+2

◦        Sometimes a minimal amount of cautery (electrical control of bleeding) may be used if needed. Southland Urology+2South County Health+2

3.       Postoperative / recovery

◦        After procedure, a catheter is placed to drain and irrigate the bladder while the urethra heals. Johns Hopkins Medicine+1

◦        Many patients stay overnight in the hospital, though the procedure itself may take less than an hour. Southland Urology+2Orange County Urology |+2

◦        The catheter is typically removed before discharge (or shortly thereafter), as patients may leave without it in many cases. Southland Urology+1

◦        Recovery may include mild urinary discomfort, burning on urination, frequency/urgency for days to weeks, sometimes mild bleeding. PMC+2Johns Hopkins Medicine+2

Indications & Suitability

•           It’s intended for men with BPH (benign prostatic hyperplasia) who have symptoms of lower urinary tract obstruction (e.g. weak stream, frequency, incomplete emptying, urgency). Johns Hopkins Medicine+2Aquablation® US+2

•           One advantage is that Aquablation can be used over a wide range of prostate sizes and shapes(including large prostates) because of the imaging + robotic control. Aquablation® US+2PMC+2

•           The goal is to relieve obstruction while minimizing irreversible complications (incontinence, erectile dysfunction, ejaculatory dysfunction) by sparing critical zones. PMC+2Johns Hopkins Medicine+2

Risks, Limitations & Evidence

•           Like all surgeries, there are risks: bleeding, infection, urinary retention (inability to empty), urethral trauma, need for retreatment, etc. Southland Urology+2Dignity Health+2

•           There is some evidence that ejaculatory dysfunction might be lower vs some conventional methods; however, data is still relatively early. Wikipedia+2PMC+2

•           A 2019 systematic review noted that, for men with lower urinary tract symptoms, Aquablation is probably as effective as TURP (transurethral resection of the prostate), but the certainty of evidence was low and more long-term data is needed (especially on serious side effects and retreatment rates). Wikipedia

•           It is not without limitations: it requires specialized equipment and training, and surgical outcomes likely depend on the experience of the surgeon/center.