Posted , 38 users are following.
Very promising new treatment for BPH now in clinical trials (Water Study):
PROCEPT’s AquaBeam combines image guidance and robotics to deliver Aquablation, a waterjet ablation therapy that enables targeted, controlled, and heat-free removal of tissue for the treatment of lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH).
2 likes, 366 replies
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dl0808 tom86211
Posted
How does aquablation stop blood from bleeding using a catheter with a ballon filled with saline?
I found this paper which explains it.
"How I do it: Balloon tamponade of prostatic fossa following Aquablation" by
Nikolai Aljuri, Peter Gilling and Claus Roehrborn on Canadian journal of urology in August , 2017. Free access.
Fig. 4 shows how it work.
"In these previous reports we mostly used standard electrocautery techniques to arrest bleeding post- Aquablation by using a resectoscope with a bipolar or monopolar electrode in coagulation mode......
Post-Aquablation prostatic substrate has a “ fluffy” appearance, making it difficult to identify sources of bleeding and thereby limiting the ability to perform effective cautery. Therefore, we subsequently used an intraprostatic balloon catheter with a technique similar to that originally reported by Foley."
"Bleeding after TURP remains an important clinical problem, with bleeding requiring transfusion occurring in approximately 3% of TURPs.7 Aquablation,.....does not use heat during tissue removal and thus requires a strategy for postoperative hemostasis. In our opinion, avoiding cautery may decrease the risk of ejaculatory dysfunction, which can be related to heat-induced damage to the seminal ducts."
"Balloon tamponade is a well-known maneuver to control bleeding of non-surgical origin. ....In urologic procedures, balloon tamponade has been reported to control post-prostate biopsy rectal bleeding as well as bleeding after simple prostatectomy.9 Balloon tamponade with a Foley catheter has been reported to treat dorsal venous complex bleeding during robotic assisted radical prostatectomy.10 Though not widely reported, balloon tamponade of venous bleeding after TURP by compression of the balloon in the bladder against the prostatic fossa has also been described.6,11"
"Initial experience with intraprostatic use of the Foley balloon catheter (i.e., the originally reported use of the device5) following Aquablation was promising, achieving acute bleeding control in most cases and no observed cases of VUAS to date....
Most reviews of Foley catheter use focus on adverse consequences of prolonged use. In contrast, our use (i.e., the originally proposed use by Foley) involves only brief placement of the catheter. Although balloon use in the bladder with traction to control bleeding is often used, reports of balloon prostatic tamponade after prostatectomy is rarer.
In early cases, Aquablation of the prostate for BPH symptom relief was followed by brief cautery to manage postoperative bleeding. The balloon catheter achieves postoperative bleeding control without the need for treatments involving heat. Avoiding damage related to heat could be associated with a lower rate of adverse effects commonly seen after TURP, such as dysuria and retrograde ejaculation."
dl0808 tom86211
Posted
How safe is aquablation and particularly does it have a high percentage of incontinence?
Below is a trial report that addresses these issues. This report also contains a lot of details and key results that help us to more fully understand aquablation. It would be very useful for us to remember these details and key results so that we could use them to compare with other technologies. This is one of the best papers in aquablation that I have read as all the key results, advantages and safety adversed events are explained in a way very easy to understand.
This paper (free access),
"Aquablation versus transurethral resection of the prostate: 1 year United States – cohort outcomes" by Veeru Kasivisvanathan, andMuddassar Hussain, on behalf of the U.S.
WATER investigators, published in Canadian Journal of Urology in August, 2018,
reports the results from the aquablation trial in the US which is part of a larger international trial.
"The purpose of this analysis was to compare Aquablation (60 patients) ..to TURP (30 patients) with respect to efficacy and safety at 1 year for the treatment of ... (BPH) in the United States (U.S.) cohort from the Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue (WATER) study." The maximum prostrate size of is 80 cc.
"The efficacy and safety outcomes at 1 year were evaluated for the U.S. cohort. The efficacy objective was reduction in ... (IPSS). The safety objective was the occurrence of Clavien-Dindo persistent grade 1 events (resulting in persistent disability (ejaculatory or erectile dysfunction or incontinence)) or grade 2 or higher operative complications."
Key Results
"Results: Ninety patients were randomized and treated between December 2015 and December 2016. Change in IPSS at 1 year between Aquablation and TURP was similar (14.5 versus 13.8, respectively, p = 0.7117). The number of subjects experiencing persistent Clavien-Dindo grade 1 or Clavien-Dindo grade 2 or higher adverse events was lower in the Aquablation group compared to the TURP group (20% versus 47% respectively, p = 0.0132). Amongst sexually active subjects, the rate of anejaculation was lower in patients treated with Aquablation than TURP (9% versus 45%, respectively, p = .0006). "
("TURP carries side effects with risks of retrograde ejaculation, bleeding, clot retention, urethral stricture, urinary incontinence and erectile dysfunction.7-11 Of note, a particularly frequent side effect following TURP is retrograde ejaculation which has been reported in up to 68% of men.12"
(Note: all the bad things we heard about TURP like bleeding, clot retention and urethral stricture didn't happen in this trial.)
Mean operative time (defined as pre-treatment visualization to insertion of indwelling catheter after resection was complete) was slightly shorter for Aquablation (27.6 minutes in Aquablation, 37.4 minutes in TURP, p = 0.0037). Mean resection time (first pedal activation to end of pedal use) was lower in the Aquablation group (3.9 minutes in Aquablation, 29.8 minutes in TURP, p < 0.0001).
(Note: aquablation hand piece spends less time in the prostrate is better for the sphincter and thus it has less chance of causing incontinence. In HoLEP, after enucleation, the morcellator has to go into the bladder to clean up the enucleated tissues. Together, the total dwell time of the laser and the morcellator is long. This could be the reason why INCONTINNENCE is so high (reported to be 10-20%) in HoLEP.
Less irrigation fluid was used intraoperatively during Aquablation compared to TURP (3.1 liters versus 13 liters, p < 0.0001).
Mean hospital length of stay was 1.4 days in the Aquablation group and 1.3 days in the TURP group. Thirty percent and 23% of Aquablation and TURP patients, respectively, were discharged with a catheter. (Note: aquablation discharged with a catheter rate is higher. But TURP's patients had such a short hospital stay and catheter time surprised me as this is one of the biggest advantages of HoLEP has over TURP. )
There was no difference in reduction in IPSS at 1 year for Aquablation compared to TURP (14.5 points versus 13.8 points, respectively, p = 0.7117), Figure 2. The IPSS quality of life score improved similarly in both groups at 1 year (decreases of 3.1 points versus. 3.4 points, respectively, p = 0.5760).
In both groups, mean maximum urinary flow rates increased markedly post-procedurally by 30 days with optimal flow rates at 90 days post procedure. This benefit persisted at 1 year post procedure and was similar for both groups (increases of 11 mLs/s versus 10 mLs/sec, respectively), Figure 2. At 1 year, post-void residuals decreased in both arms similarly (decreases of 54 mLs versus 39 mLs, respectively). At 1 year PSA reduced in both arms by a comparable amount (-1.0 ng/mL and -0.7 ng/mL, respectively).
(Note: BPH symptoms would be greatly relieved in a month and they would be gone in three months. Afterwards, Pee like in ur 20's.)
Significantly fewer men experienced persistent Clavien-Dindo grade 1 or Clavien-Dindo grade 2 or higher adverse events following Aquablation compared to TURP (20% versus 47%, respectively, p = 0.0132) through 1 year. The rate of Clavien-Dindo grade 2 or higher was lower for Aquablation (13.3%) than TURP (30.0%). The Clavien-Dindo grade 1 persistent events was lower for Aquablation (6.7%) than TURP (30.0%) which included ejaculatory dysfunction, erectile dysfunction, and incontinence. No subjects in either arm experienced incontinence or erectile dysfunction. Amongst sexually active subjects, the rate of anejaculation was lower in patients treated with Aquablation than TURP (9% versus 45%, respectively, p = .0006).
(Note: no incontinence, a major issue for HoLEP. The adversed events in aquablation is more than 50% lower than TURP. )
One TURP subject (3.3%) and one Aquablation subject (1.7%) underwent surgical retreatment for BPH within 1 year from the study procedure."
Discussion
"The main findings of this study were that Aquablation improved LUTS at 1 year at a level comparable to the standard of care TURP, but had fewer adverse events, notably fewer men experiencing retrograde ejaculation. Improvements at 1 year were seen in IPSS, flow rate, post-void residual and quality of life from urinary symptoms.
Additional findings in this study were that the benefits seen in improving LUTS appear to persist through to 1 year post-procedure.
Improvement in urinary flow rate and post-void residual seen in the study are consistent with those seen in the literature for ablative prostate surgical techniques, notably laser enucleation18 and laser photovaporisation.19
A major advantage of the Aquablation procedure is related to the preservation of ejaculatory function, which is thought to be due to the accurate tissue destruction sparing the verumontanum while utilizing a heat-free mechanism to remove tissue. In TURP, ejaculatory dysfunction is very common and is thought to relate to heat damage to the ejaculatory duct.19
Surgeons that participated in the study were very experienced with TURP. Despite having far less experience with aquablation, efficacy outcomes were still comparable, highlighting that the learning curve with the technology is not significant.
It is also encouraging that the large U.S. cohort of the study had results consistent with the overall study group. "
.
kenneth1955 dl0808
Posted
dl0808 kenneth1955
Posted
Hello Ken,
"..but with them getting rid of the prostate and only leaving the shell. What will be the volume left with everything gone. Not much I guess"
all ablative technologies, TURP, GLL, HoLEP and aquablation, cut away or removed more or less the same volume of tissues. Sure there are differences bout not large differences. Aquablation does not remove anymore tissues than other technologies. For example, in HoLEP enucleation means that it "peels" off the adenoma or overgrowth from capsule, like peeling the meat of an orange away from its skin. In openprostectomy, that is what the surgeon does, he cut open the prostate and peel off the adenoma from the prostrate capsule using his index finger.
kenneth1955 dl0808
Posted
Yes I know that I have a few friends that had Holep surgery and that is how I explained it. But with getting rid of the inner prostate you get rid or damage the seminal canal which make up 70% of your ejaculation. The other 30% of fluid is made up by the prostate. So what is the volume left That is what I want to know and if it is worth having the procedure. I have read all the doctor note in the trail but that is not explained. They say it safe but what is the volume of the ejaculation. I live in Orlando Florida If I don't get a answer from the doctor. Jacksonville is only 4 hours away I will go and ask myself. You have a lot of doctor saying how get it is but I want to know everything. They keep saying they can save the ejaculation but with destroying the prostate and leaving the shell What is left for the ejaculation. The 30% of the fluid from a normal size prostate that is cut to 1/3 You not going to get much. There has to be a way to map the prostate out to avoid the area were the seminal canal is. I want to know. And I will write Dr. Peter Gilling if I have to. Ken
dl0808 kenneth1955
Posted
First , I thought u are a faithful for Urolift . Why interested in aquablation?
secondly, I feel that u have too much faith in the MDs. Most of them are practitioners not researchers. They are u likely to know the answers.
on th contrary, GIlling is a researcher, but he is so famous and busy, I doubted u will ever get a reply.
the only way left is to do research on ur own. That is what I had done. My research is contained in my post "Retrograde Ejaculation or Ejaculation Preservation ...."
i don't believe that the semen production is affected by BPH surgery, but the direction of the semen flow is. When the verumontanum is affected by the surgery, one get RE, that is semen flows backward to the bladder, and when it is not affected, the semen flows in the opposite direction. So there is a in between situation, where part of the semen flows to the bladder and where the rest flows in the correct direction. Then one sees at the output, a reduced amount of semen.
the technique of ejaculation preservation was derived from a scientific experiment. 30 men were asked to masturbate with a recto recorder in place. The scientists then looked at the recorder to see what we're the muscles or tissues responsible for the forward ejaculation. They identified those tissues were within 1cm of the verumontanum. Before that experiment, they also knew that BPH patients who had an transurethral incision done, that is a single incision from the bladder neck toward the verumontamum but stop the cut just ahead of the veru, had only 10 to 20 % of RE. These two experiments agreed with each other. That was how the ejaculation preservation technique was developed.
But like I said Green laser has very precise control where the tissues the surgeon wants to cut, thus EP-GLL had achieved 90% EP or 10% RE.
grant u that I don't know what was the percentage that semen flowed backward and forward.
if u look at the figure in GIlling's paper, "how i do Aquablation .." , it shows the contour or profile of the Aqua cut, it totally avoided the veru and the surrounding area. Thus, I have no problem in accepting the 10% RE number.
Further, the aquabeam team, because after Aqua, the left over tissues were fluffy, it found it was difficult to use a TURP electrode button to cauterize the bleeders. They just couldn't pin point where the blood was coming from. They had no choice but to use a saline filled balloon to press on the entire prostate fossa, like a blanket to kill a fire. And in the process, they found that the 10%RE was further reduced. This proved that heat caused RE.
dl0808
Posted
More:
look at this statement by GIlling:
"Among sexually active men without the condition at baseline anejaculation was less common after Aquablation than after TURP (10% vs 36%, p = 0.0003). The anejaculation rate after Aquablation was somewhat lower when posttreatment cautery was avoided (7% vs 16%, p = 0.2616)."
Thus , without heat cauterization, there was a factor of two lower RE, that is from 10% to 5%, unless u don't believe the results of the trial. The 10% was obtained from a mix of heated and no heat haemostasis.
The trial has the answer for the amount of ejaculate u were asking. It is contained in the Male Sexual Health Questionnaire© (MSHQ). Question 9. See for example,
eprovide.mapi-trust.org/content/download/28388/283522/version/1/file/MSHQ_AU1.0_eng-US_ReviewCopy.pdf
dl0808
Posted
More:
look at this statement by GIlling:
"Among sexually active men without the condition at baseline anejaculation was less common after Aquablation than after TURP (10% vs 36%, p = 0.0003). The anejaculation rate after Aquablation was somewhat lower when posttreatment cautery was avoided (7% vs 16%, p = 0.2616)."
Thus , without heat cauterization, there was a factor of two lower RE, that is from 10% to 5%, unless u don't believe the results of the trial. The 10% was obtained from a mix of heated and no heat haemostasis.
The trial has the answer for the amount of ejaculate u were asking. It is contained in the Male Sexual Health Questionnaire© (MSHQ). Question 9. See for example, Google: eprovide mapi-trust org MSHQ
dl0808
Posted
the trial also used this questionaire IIEF which answer all ur sex related questions. The form can be found by
google ktph com sg
kenneth1955 dl0808
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jimjames dl0808
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Gilling: "Among sexually active men without the condition at baseline anejaculation was less common after Aquablation than after TURP (10% vs 36%, p = 0.0003). The anejaculation rate after Aquablation was somewhat lower when posttreatment cautery was avoided (7% vs 16%, p = 0.2616)."
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Please show me the doctor who has only a 36% anejaculation (retro) with standard Turp. Something is wrong with the numbers and I suspect the questionaire. I will be happily surprised if Aquablation only has a 10% rate of retro but I certainly wouldn't want to bet my ejaculatory ducts on it. Let's see what the real world figures are a year from now.
Jim
dl0808 jimjames
Posted
Hello Jim.
ejaculation preservation is science not black magic. All the surgeon needs to do is not to cut those tissues near the verumontanum. But some surgeons may not care. In order to give the best outcomes, they cut aggressively to give the widest channel opening. And oops! The poor patients loses his ejaculation. Worse yet, The patient before the procedure is fore warned he would lose his ejaculation with the statement "this is the price u have to pay." So the patient never know he has an option which depends on the surgeon's hand and well, his heart as well.
it is possible that not all BPH urologists know the EP technique. However, those who were in the WATER trial are knowledgeable researchers. I am sure they knew the EP technique. So when they did TURP, they paid attention when they were near the veru and spared the surounding tissues.
EP-TURP had achieved 10% RE just like aquablation.
Just for u, I did an Internet search and found this paper:
Ejaculation-Preserving Transurethral Resection of Prostate and Bladder Neck:
Short- and Long-Term Results of a New Innovative Resection Technique
Saladin Helmut Alloussi, MD,1 Christoph Lang, MD,2 Robert Eichel, MD,3 and Schahnaz Alloussi, MD1
Abstract
Introduction: Loss of antegrade ejaculation is a risk with conventional resection of the prostate (transurethral resection of the prostate [TURP]). The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with the novel ejaculation-preserving TURP (epTURP). Patients and Methods: Prospective evaluation of 89 consecutive patients with bladder outlet obstructions aged 27 to 78 years, enrolled from June 2001 to January 2005. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; International Index of Erectile Function-5 [IIEF-5 + ] with two additional questions) measures of function. All patients received follow-up examinations at 3 and ‡ 60 months.
Results: Overall, 87 and 63 patients were evaluated after 3 and 60 months, respectively. Antegrade ejaculation was preserved in 79 of 87 (90.8%) patients at 3 months. Significant improvements in maximum flow rate (+ 14.3 mL/s), micturition volume (+ 71.6 mL), and PVR (- 59 mL; p £ 0.002 for all) were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced (mean change of 18.3 and 2.9, respectively; p<0.001). Improvements were maintained at 60 months. No serious adverse events were reported. Eight (12.7%) patients received a second epTURP due to the development of bladder neck scar tissue during long-term follow-up.
Conclusion: Antegrade ejaculation was preserved with the use of epTURP with excellent outcome. Observed symptomatic and functional outcomes were comparable with conventional TURP. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology.
kenneth1955 jimjames
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jimjames dl0808
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dl: if u look at the figure in GIlling's paper, "how i do Aquablation .." , it shows the contour or profile of the Aqua cut, it totally avoided the veru and the surrounding area. Thus, I have no problem in accepting the 10% RE number.
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If you accept the 10% antejaculation for Aquablation then you have to accept 36% for TURP, the latter of which is outside of any published literature except if ep TURP was performed which was not noted. Both the 10% and 36% were derived from patient questionnaires mailed after the procedure with no follow up noted. Did the patients understand the question? Had the patients tested their sperm ducts? Did the patients even know what antejaculation or retro ejaculation was? Potentially a more accurate measure would be the percent responses of antejacultion vs TURP which would put antejaculation with Aquablation closer to 22%. And btw Gilling isn't too busy to answer emails he just want give you any information if you aren't an MD or researcher.
Jim
Jim
jimjames dl0808
Posted
DL: ejaculation preservation is science not black magic. All the surgeon needs to do is not to cut those tissues near the verumontanum....
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Hello DL, We seem to be talking past each other. What you wrote above is not new to me. I started a thread here on EP TURP over a year ago. I have corresponded with the ep TURP trial doctors. I am very familiar with what you say, but that is not the point I have making.
The point has to do with Gilling's retro numbers and perhaps his reporting methods for reasons I have mentioned several times in this thread. You are assuming Gilling performed EP TURP and an EP Aquablation. You cannot assume anything and in fact wouldn't you think that something out of the ordinary such as EP Turp would be documented in his study? But that's also speculation. Do you want to bet your ejaculatory ducts on speculation? I'll bet mine on trial data backed up by some real world data neither of which at this juncture in time supports only 10% retro for Aquablation as I see it.
Jim
jimjames dl0808
Posted
DL< I'm giving up trying to answer you post because for some reason it goes into moderation. Maybe check back tomorrow. Short version is that I know all about EP turp and in fact started a discussion on it here over a year ago. My point was not about ep turp but about Gilling's numbers and methodology. You can't assume anything other than what has been published and neither supports the 10% retro figure to me.
Jim
kenneth1955 jimjames
Posted
Good morning guys. After watching the videos and reading the papers. Even if they save the Veru Montanum you are not guarantee to save your ejaculation. But why? If that is save you should be able to have your ejaculation. What else are they doing that is messing it up. Watch the EP surgery and the Ablation to me they destroy to much tissue to make the tunnel and they are doing to much around the bladder neck. Your ejaculation will only consist of the fluid from what is left of the prostate because they damage the seminal canal connections. What will be the volume and is it worth the effort to save 10% of the ejaculation. Going to see what they say from the e-mail Still waiting for a answer. I think While I'm waiting I will send Dr. Gilling a e-mail. I know I am nic picking on the volume of the ejaculation. But if I am going through a surgery to save it I what it all I do not want it to change. Have a nice day all Ken
dl0808 jimjames
Posted
i also feel that the company should compare Aqua with Urolift and HoLEP on their website. Many patients probably want to know what are the advantages and disadvantages. I am struggling to answer this question.
dl0808 jimjames
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kenneth1955 dl0808
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kenneth1955 dl0808
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kenneth1955 dl0808
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DL & Jim. I think that may be a good Idea to compare Aqua with Holep because they both cut away at the prostate. There score may be close together. Right now I read Aquablation is 10 to 20% but Holep I just read today that retro is 70%. It all depends on the doctor I quess. With Urolift you have no cutting of the prostate it is just pull apart. So I don't think they can compare it to the other ones. No retro at all and no other side effect. The only way you can get retro from having a urolift is if the doctor but the bar to close to the bladder neck. The doctors have to go for a training to do that. I heard that from my doctor and one inventor that I am in contact with. The other score are a little under Aqua & Holep but the Quality of life score is 100%. And I also read that patients that had the Urolift that they would recommend the procedure 89%. We will see I hope it just does not turn out to be one of them fly by night procedure We deserve to know all we can. It is our right. Ken
dl0808 kenneth1955
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jimjames dl0808
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DL, Can you please copy and paste and/or orovide a link to the MSHQ Questionaire. Also how long after aquablation was it completed and any follow ups beyond that. I think the data that mattes to most of us won't be until the one year point.
Jim
kenneth1955 jimjames
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dl0808 jimjames
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1) MSHQ medical questionaire for BPH link:
https://eprovide.mapi-trust.org/content/download/28388/283522/version/1/file/MSHQ_AU1.0_eng-US_ReviewCopy.pdf
2) as u know, now the latest info we have is the 6 mo results from the WATER trial. This is the most up to date and extensive info about aquablation. The Aqua results so far, in my view, impressive. But seems unlikely there will be more info in the next several months as the paper was just published in May, 2008. It takes a long time for a peer reviewed paper to be published
Gilling did a smaller but one year long multi center trial between New Zealand and Australia. It showed that the results at month 6 were about the same at month 12.
thus, it is reasonable to believe that month 12 WATER results will be about the same as month 6.
i posted all the above trial results in this thread and it did consume a lot of time. With this knowledge under out belt, I believe that we know enough to have a meaningful conversation with our urologist and could make an informed decision.
jimjames
Posted
I still have more questions than answers. IMHO at this point in time the only reasonable thing to do re Aquablation is to wait a year or two until we see how real world data compares to what I see as confusing and contradictory trial data. I am an early adaptor when it comes to my Iphone but not with my prostate and ejaculatory ducts.
Jim
dl0808 jimjames
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jimjames dl0808
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Point well taken and your information is appreciated however my take is to wait at least a year. More aggressive medical intervention or CIC are two ways to extend watch n' wait safely. That said, if I had to choose from the lot of what is available I think at this moment in time I'd go with Rezum, Urolofit or an ep GL, assuming some of those numbers check out, rather than chance Aquablation based only on trial data.
Jim
kenneth1955 jimjames
Posted
Jim & DL First of all I want to thank DL for all his hard work and Typing of all the information on Aquablation. It take a lot of time to do that. I wish more men would that the time to research there procedure before that go for surgery. It would help them know what is going on and what will happen. Also we will have to see what the next 2 years will bring. This will be it for now still wanting for a reply from Mr. Barbar I think he is mad at me. I took what he said wrong. I wrote him a letter to apology. I will wait a few hours and see if he e-mail me back. It's going on 11 PM there in the UK. Then I will come back and say what I have to say Later my friends Keny
dl0808 kenneth1955
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kenneth1955 dl0808
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jimjames kenneth1955
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Agree, Both DL and yourself have added a lot to the table on what we know so far about ablation. This is good. At the same time we have to understand that trial data has its limitations because of inherent biases not to mention the marketing team after the trials. In this particular case, some of the trial data regading RE just doesn't add up for reasons I have stated before. So in any case, but especially if RE is an issue, I would be cautious jumping in too soon and have Aquablation until we have some more real world data perhaps in a year or two. One could spend that time trying meds or CIC and if neither is suitable then consider something with more of a track record such as rezum, GL or urolift.
Jim
kenneth1955 jimjames
Posted
Thank you Jim. But I'm not getting on the band wagon yet. Talking with Mr. Barbar was very enlightening I found out that after talking with the patient and knowing there concerns the doctor does the mapping in real time. When you are asleep. You will not know what has been ablated until you wake up. You can't identify the prostatic or common ejaculatory ducts. ( The connection to the seminal canal ). The only thing you can do is to be conservative at the bladder neck where the ducts emerge in the hope of higher rates. Aquablalation like any other procedure remove half of the prostate to make the tunnel to achieve the maximal relief of the obstruction of the flow out of the bladder. So being that the prostate makes up 30 % of the ejaculation fluid that alone will have a impact of the volume of the ejaculation. The only thing that the Aquablation will do is spare the area of delivery. With that being said you will only have about 15 % of a ejaculation. They are only concerned is helping you pee. I do appreciate what they are trying to do but there is no lee way of doing the ablation. They will do the whole prostate from the bladder neck down. Now you have to look at it is this worth a few drop of ejaculation. Now there is something I have to say about the Rezum procedure. I think this would be the same thing. When they do the Rezume Procedure they do not touch the Verumontanum. They inject the steam into the tissue of the prostate. So they will destroy the connection of the seminal canal. So all you have is your fluid from the prostate to make up your ejaculation. We have had men on here that have said that a few week after they have a ejaculation a less amount and by a few months it gone. That is because as they heal the prostate is getting smaller and does not make that much fluid. I can say that they still have there ejaculation but not enough to push it forward. It is still in the urethra. I think both would be good in time but they should be able to adjusted the procedure to meet the man's concerns. I feel it can be done Rezum maybe not so many injection on the left side and Aquablation maybe only the one side. In conclusion at 63 I am not ready to give up anything just to pee better. Just because we are older and are not having kids doctor tell us we don't need it. But for me I feel that My ejaculation and my orgasm go together even if they are 2 different functions. But it is a sexual function just like sex is a function. We will see what the next 2 years will bring. God help them and lets hope for the better. Good Health to all. Ken
dl0808 kenneth1955
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kenneth1955 dl0808
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I came up with that because. They destroy the connection of seminal canal ( makes up 70 % of the ejaculation ) and if the prostate makes up the other 30 %. With any procedure they get rid of half of the prostate. So your ejaculation volume will only be made up from what is left of the prostate 15 % I am talking about the volume will only be 15 % I'm not talking about the procedure outcome. We will have to wait the 2 years and see. I feel it has to be adjusted to meet the patients. I don't know if men will be happen with the ejaculation of only 15% Ken
dl0808 kenneth1955
Posted
Hello Ken,
U are a very helpful and popular person in this forum. Many readers may be influenced by ur opinion. U may want to consider what u say is 100% accurate before posting. I feel that u will help readers more this way.
Muti continent aquablation trials were reporting after aquablation, the antegrade or retrograde ejacualtion rate were 2-10%, ur 15% statement is a stark contrast and may not do justification for aquablation.
i mean well and I hope it didn't come across as offensive nor critical.
kenneth1955 dl0808
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DL You are taking it the wrong way. I am not saying that the trail out come is 15 % I am talking about a man ejaculation will be at 15 % As I said The seminal canal give you 70 % of the ejaculation And when they do any prostate surgery they take at least 1/2 of the prostate. The prostate give you 30 % but if they take 1/2 that leave you with 15% for your volume Do you get what I am saying. So we have to see if a man will be happy with only the 15% I read all of the trail and I see where they say 2% or 10%. I don't take that as offensive nor critical. You are just taking it the wrong way. I am not talking about the trails I am talking about What volume a man is left with 15 %. You have done a good job on giving a lot of good information. I wish more men would take the time to research there procedure Take care Ken
dl0808 kenneth1955
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Hello ken
i must admit that I have much to learn as I don't understand that subject.
it was a friendly chat!
kenneth1955 dl0808
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dl0808 kenneth1955
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do u know how to unsubscribe a thread (getting too many emails)?
thanks.
kenneth1955 dl0808
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Hello all. I got a reply from Dr. K. I sent him a e-mail because I thought Aquablation & FLA were about the same being that they are mapped. Boy was I wrong. This is what he wrote First of all Aquablation uses ultrasound guidance instead of MRI guidance.Second it is performed transurethrally instead transrectally. Aquablation is essentially a power wash which causes a jet of water to blast the prostate away. This is a far cry from the MRI precision of the laser. With the precision of the MRI guidance the doctor can avoid the ejaculatory duct which connect the seminal vesicles to the urethra. Aquablation can not. In medicine one cannot guarantee the outcome. But I feel that FLA has it advantages. Also FLA is mapped out before you have the procedure but Aquablation is not it is not mapped until you are asleep. We still have a lot to learn about all procedure and doctor have to learn to listen to the concerns of there patients. I know they are trying but we need not to give up control of our body's. They are doing these procedure to us. I am not looking to pee like a teenager I'm just looking to pee without giving up things that are dear to me. We just have to fine a doctor that care enough about us and our problems And life goes on Ken
kenneth1955 dl0808
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hank1953 kenneth1955
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kenneth1955 hank1953
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Camster kenneth1955
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kenneth1955 Camster
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hank1953 dl0808
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kenneth1955 hank1953
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dl0808 hank1953
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I believe many readers are reading posts of this forum looking for information. (At least,I did) Some of us, have easy access to the latest information or have more experience, i do hope that we make sure what we write is correct and unbiased, else we may mislead some readers to make the wrong decision on thier treatment plans.
Ken does have good heart. The way he chased down info and very helpful to almost everyone are good attitudes.
kenneth1955 dl0808
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kenneth1955 Camster
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I forgot to let you know. I never got a reply back from the company I sent for some information either. Don't know what they are up to. Have a good day Ken