As men get older, they often notice urinary problems like needing to pee more often or feeling like they have to rush to the bathroom. Those symptoms are linked to an enlarged prostate, a condition also known as benign prostatic hyperplasia (BPH).
“Virtually all men eventually develop an enlarged prostate, to some degree. Not everyone develops symptoms, but many do,” says Hans Stricker, M.D., a urologist at Henry Ford Health. “About 8 million men in the United States are being treated for BPH—and there are many others who have learned to put up with the symptoms but would benefit from treatment.”
One such treatment is aquablation, a surgical procedure that has grown in popularity over the last decade or so. Dr. Stricker explains how aquablation works and why you shouldn’t ignore symptoms of an enlarged prostate.
What Is Benign Prostatic Hyperplasia (BPH)?
The prostate is a gland in the pelvis that makes fluids used in ejaculation. The tube that carries urine (urethra) runs right through the middle of the gland, Dr. Stricker explains.
It’s not clear why, but the prostate tends to get larger with aging. As it does, it presses on the urethra, causing it to narrow. That leads to the symptoms of BPH:
- Frequent urination
- Trouble fully emptying the bladder
- Urgency (having to rush to the bathroom)
- Urinary tract infections (UTIs)
Initially, those bladder symptoms can feel like an annoyance. But as they progress, they become more troublesome. “For many men, one of the biggest challenges is having to get up to use the bathroom many times a night,” Dr. Stricker says. “That can interfere with sleep and really impact your quality of life.”
BPH isn’t associated with prostate cancer, but it can still cause problems. If BPH becomes advanced, the condition can damage the nerves that control the bladder. In extreme cases, men may permanently lose the ability to control their bladder. “That’s why it’s so important not to put off seeing a doctor if you have symptoms,” Dr. Stricker says.
Enlarged Prostate Treatments
Medications can improve BPH symptoms like frequent urination and urgency. Unfortunately, though, they don’t actually shrink an enlarged prostate. Over time, the gland continues to grow. When that happens, surgical options can improve symptoms and prevent permanent nerve damage.
Meet With A Urologist
“Around a dozen different surgical options are available to treat BPH,” Dr. Stricker says. One of the most common options has been transurethral resection of the prostate (TURP). In TURP, a surgeon inserts a scope into the urethra to reach the prostate. Then the surgeon uses a cutting tool attached to the scope to remove excess tissue. That frees up space around the urethra so urine can flow freely.
While TURP remains an effective choice, a newer procedure called aquablation has quickly gained attention. Like TURP, aquablation doesn’t require incisions. It also uses a tool inserted through the urethra. But it uses a high-powered water jet to break up and remove tissue from the prostate. That water jet targets the extra tissue with precision, Dr. Stricker says.
“Compared to TURP, aquablation is both faster and much more controlled, so recovery is usually a little easier,” he explains. It’s also suitable for very large prostates, he adds. With TURP, the risk of complications increases for prostates over a certain size. That’s not the case with aquablation.
“I often recommend aquablation because it can handle most any size and shape prostate, and it works really well,” Dr. Stricker says.
Aquablation: What to Expect
Before an aquablation procedure, your doctor will use ultrasound to take detailed images of the prostate. A computer program uses those images to create a personalized plan for the operation.
Aquablation is done under general anesthesia, so you won’t be awake for the procedure. Most patients spend a night in the hospital after aquablation. Patients typically have a urinary catheter in place for up to four days. The catheter collects urine while tissues heal.
It’s not uncommon for patients to experience an increase in symptoms like frequent urination and urgency in the first week or two after surgery. “Symptoms might initially get a little worse before they get better. But after a week or two, the vast majority of men have significant improvement in their symptoms,” Dr. Stricker says.
You should avoid strenuous activity and heavy lifting the first few weeks as you recover. But most patients can otherwise engage in normal activities.
The risks of aquablation are similar to the risks associated with other surgeries for enlarged prostates, Dr. Stricker says. These include:
- Bleeding
- Infection
- Scarring
- Impaired ability to ejaculate
But because aquablation is so precise, Dr. Stricker says, it has a lower risk of damaging the ejaculatory ducts compared to other BPH treatments.
Seeking Treatment for Enlarged Prostate
While aquablation can be an effective treatment for BPH, surgery isn’t usually the first step. Most men start with medications to help manage symptoms.
If you’re beginning to experience signs of an enlarged prostate, talk to a urologist, Dr. Stricker says. “This is a common condition, and we have a lot of tools to manage it,” he adds. “It’s important to seek treatment when symptoms are impacting your quality of life.”
Reviewed by Hans Stricker, M.D., a urologist who sees patients at Henry Ford Hospital in Detroit and Henry Ford Medical Center – Lakeside in Sterling Heights.
