Aquablation.pdf

Aquablation is a surgical procedure for treating benign prostatic hyperplasia (BPH) in men with large prostates (> 150 mL). The American Urological Association (AUA) guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and very large prostates (> 150 mL).

Patient selection involves a standard assessment, including an International Prostate Symptoms Score (IPSS) questionnaire, sexual health inventory questionnaire, post-void residual, and transrectal ultrasound volumetric study. The Aquablation procedure uses the AquaBeam System, which combines imaging, software, and robotics to standardize the procedure.

The procedure involves stopping anticoagulation medications, initiating general or spinal anesthesia, and inserting a transrectal ultrasound probe for optimal imaging of the prostate. The surgeon uses planning software to mark the target resection contour and robotically executes the ablation of tissue using a high-velocity waterjet.

For men with very large prostates (> 150 mL), additional procedural steps are required due to the length and depth limitations of the handpiece. The surgeon may need to perform multiple passes with the waterjet, and the approach involves positioning the handpiece as anterior as possible in the bladder outlet and planning the angle accordingly.

Key considerations include:

Patient selection and assessment
Use of the AquaBeam System for standardized procedure
Additional procedural steps for very large prostates (> 150 mL)
Multiple passes with the waterjet may be necessary
* Planning the angle accordingly for intravesical median lobe

The procedure has a short learning curve and reproducible operating times, making it a viable option for treating very large prostates (> 150 mL).