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Aquablation for BPH

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tom86211
tom86211

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).

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  • dl0808
    dl0808 tom86211

    Posted

    1) This is the only real life video on  Aquablation that I could find on YouTube.  If u want to understand aquablation, this may worth to watch it. 

    https://youtu.be/nSEhQ4I5YX0

    or in YouTube search dr. Enrique Rijo

    2) If u are interested in ejaculation preservation, this is how it is done:

    https://youtu.be/LsMKrOHPKIM

    ?or in YouTube search dr. Enrique Rijoal life yutube video for  Aquablation :

    If u are interested in ejaculation preservation, this is how it is done:

    https://youtu.be/LsMKrOHPKIM

    or in YouTube search 

     

    • kenneth1955
      kenneth1955 dl0808

      Posted

      I don't know if this has anything to do with anything Got a e-mail from a nurse she talk to doctor in Georgia He only does GL   He said that no matter what procedure you have on the prostate you will end up with retro ejaculation  only Rezum does not cause retro.  I think he is behind the time  Have a good day Ken 

    • dl0808
      dl0808 kenneth1955

      Posted

      I also had called several urologists who do GLL. All of them said they don't do EP. I believe it is close to impossible to find some one who is willing to do EP except New York Urology.

    • kenneth1955
      kenneth1955 dl0808

      Posted

      Not many are doing it.  They believe that it is not good for the patient.  They will not get the full benifit of the procedure  Ken
  • dl0808
    dl0808 tom86211

    Posted

    1) If U are interested in fully understanding aquablation, this video may worth ur time to watch it.

    This is the only real life video on  Aquablation that I could find on YouTube.  The operation was done by dr. Enrique Rijo.

    In YouTube search box, search 

    nSEhQ4I5YX0

    2) If u are interested in understanding the  ejaculation preservation technique, this video also by Rijo shows how it is done.

    In YouTube search box, search 

    LsMKrOHPKIM

    Note aquablation uses the same Ejaculation Preservation Technique described in the above video. Thus, it can achieve the same RE percentage as GreenLight Laser which  is could be as low as 10% RE as quoted in some scientific studies.

  • dl0808
    dl0808 tom86211

    Posted

    I am in search of a suitable  BPH intervention.

    If u are considering having aquablation or HoLEP, u will not be able to find a head to head comparison between the two. However, there are comparison studies between aquablation and TURP and between HoLEP and TURP. By studying these two types of comparison, hopefully we could form an opinion about aquablation vs HoLEP.

    For functional outcomes, we know that HoLEP is better than (but not very much) TURP as the enucleation of HoLEP seems to remove more adenoma than TURP; likewise aquablation seems to be slightly better than TURP. Thus, in my mind, functional outcomes such as IPSS, Qmax, PVR are not the issues as we are comparing two technologies both of them are better than TURP in functional outcomes. Sure for aquablation there is no durability long term data, but there is a study which suggests that the 12 month data most likely would extend to 5 years. Most of us, could accept that suggestion. 

    Also, it seems creditable that for retrograde ejaculation, aquablation has a big edge over HoLEP, it is about 10% (aquablation) vs  >70% (HoLEP).  There is scientific evidence that supports this claim.

    It is the complications that we would like to know. We already knew that HoLEP has well known advantages over TURP, that is shorter hospital stay and shorter catheter time (maybe also less incidence of blood transfusion?). So let's take this out and ask how about other complications?

    I found this paper that helps to shed light on complications:

    "Current status of holmium laser enucleation of the prostate" by

    Shigemura, Katsumi and Fujisawa, Masato, published in December 2017

    ( onlinelibrary.wiley.com/doi/full/10.1111/iju.13507)

    Quotes:

    "HoLEP versus TURP

    HoLEP (including enucleation and morcellation) involves longer operative times. Perioperative complications are less numerous with HoLEP, with a lower rate of blood transfusion after HoLEP than TURP, and better maintenance of serum sodium and hemoglobin levels in HoLEP. Importantly, HoLEP resulted in a shorter catheterization duration and length of hospital stay than TURP. Shishido et al. stated that hospital stay of HoLEP patients was 6.6 ± 2.3 days, even though hospital stay for TURP was 9.4 ± 2.2 days.44 Postoperatively, there are no significant differences between HoLEP and TURP in regard to AEs, such as acute urinary retention, clot retention, recatheterization, short-term reoperation, postoperative UTIs, postoperative storage symptoms and urethral strictures.45

    ..........

    .........

    Post-HoLEP UI

    UI is one of the most troublesome postoperative complications of HoLEP, both for patients and clinicians.50-53 It is shown to occur in almost 20% of patients, most of whom recovered within 1 year.51-54 Postoperative UI occurred in 16.6% of a representative study cohort, and 80% recovered within 3 months. One risk factor is operation time. The longer the resectoscope remains for enucleation in the urethra, the higher the possibility of sphincter damage."

    There are a lot of details when comparing two technologies.  However , if we just look at the big picture, the authors wrote, "Postoperatively, there are no significant differences between HoLEP and TURP in regard to AEs, such as acute urinary retention, clot retention, recatheterization, short-term reoperation, postoperative UTIs, postoperative storage symptoms and urethral strictures.45"

    AE means adverse events. They have equal complications, this is very good to know

    It is also well know that HoLEP has problem with INCONTINNENCE. 

    On the steadyhealth HoLEP forum, some HoLEP recipients said that they had been wearing pads for many months-- miserable life.

    Peter Gilling in his 21 men muticenter  trial stated that there was NO INCONTINNENCE. Is this an accurate statement? 

    Also the Japanese authors wrote, "The longer the resectoscope remains for enucleation in the urethra, the higher the possibility of sphincter damage.". If this is true, we know that in aquablation the resection time is only about 4min independent of the prostrate size. So how long is the water jet inside the prostrate? If it is short, it would support GIlling's claim.

  • dl0808
    dl0808 tom86211

    Posted

    This paper seems to be the latest investigation into retrograde ejaculation and ejaculation preservation.

    Invited Review from World Journal of Urology:

    "Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment" by Souhil Lebdai, et al., published in July 2018

    .............

    "Methods

    A systematic review of the literature was carried out on the PubMed database using the following MESH terms: “Prostatic Hyperplasia/surgery” and “Ejaculation”, in combination with the following keywords: “ejaculation preservation”, “photoselective vaporization of the prostate”, “photoselective vapo-enucleation of the prostate”, “holmium laser enucleation of the prostate”, “thulium laser”, “prostatic artery embolization”, “urolift”, “rezum”, and “aquablation”.

    Results

    The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively."

    NOTE:  for aquablation the ejaculation preservation rate is 90% (or the retrograde ejaculation rate of 10%) whereas Urolift is 100% and whereas TURP is 34%. 

    However, Urolift is non ablative, the improvement in objective outcomes such as Qmax and PVR and improvement in subjective functional outcomes such as IPSS are not as good as ablative techniques such as aquablation, TURP, GLL as pointed out by GIlling. (perhaps the change in these parameters, non ablative is only half of the ablative techniques?). So this is the tradeoff.

    • kenneth1955
      kenneth1955 dl0808

      Posted

      I would not trade off.  The Qmax , PVR and the IPSS are very near the other result.But no different in quality of life.  My doctor tells me I'm unique.  I am not ready to trade off anything.  I also sent a a e-mail to the company I want them to explain to me If once the machine is started can it be stopped if it goes off track.  And also I want to know the volume of the ejaculation.  They are getting rid of the prostate they are also getting rid of the seminal canal with provide 70 % of the ejaculation.  What is left after they get rid of most of the prostate.  And what about the nerve bundles that are attach to the prostate.  I want it all explained.  I hope the next two year are better.  Ken 

    • JerseyUrology
      JerseyUrology kenneth1955

      Posted

      Yes, aquablation appears to be very promising so far.

      We are pleased to be one of the first practices to offer it!

    • kenneth1955
      kenneth1955 JerseyUrology

      Posted

      Yes I heard that.  Very good.      We also have one that just opened up in Jacksonville Florida I sent a letter to the company.  And I was just getting ready to e-mail the doctor in Jacksonville to voice my concerns Have a great day  Ken  
    • kenneth1955
      kenneth1955 dl0808

      Posted

      I found Dr Gilling paper on twitter looking at the site that is opening in Jacksonville I listened to the video but I did not see a video of the procedure that you were taking about.  I will look more  Ken 
    • jay111
      jay111 JerseyUrology

      Posted

      Hi JerseyUro- what sort of retro, E.D., and incontinence stats are you getting so far in your  practice..? Thanks for your input and help... Cheers- J
    • jay111
      jay111 JerseyUrology

      Posted

      PS-"what sort of retro, E.D., and incontinence stats are you getting so far"... [In relation the Aquablation..?] Thanks 

    • dl0808
      dl0808 kenneth1955

      Posted

      Ken,

      there is is a foot padel controlling the on off of the water jet. I have been trying  to find out what is the calibrating process? how does the surgeon know when to stop the cutting so that it won't  cut through the capsule? Is the force of the jet controllable or programmable I.e for nearer tissues, the jet force is smaller and for further tissues, the jet force is larger. Another thing is how fine is the water jet. For laser beams , the area of the beam is about a mm or so. One area that aquablation shines is large prostate and large medium lobe that protrudes into the bladder as the cut starts from inside the bladder.

      the amount of ejaculate is contained in a questionaire, called IIEF. There is no nerve inside the prostatic cavity.

      there could be a lot of patients who are interested in having better functional outcomes than a short term fix like those offered by non ablative techniques  (Urolift, rezum, etc). Just look at the number of patients who selected HoLEP, TURP, GLL as well as the huge number of scientific studies for these technologies. Urolift is a minority.

      Fixing the the problem long term is important to a lot of folks. Who want to do the BPH surgery twice? For a HoLEP patient,he may have to wear a pad up to a year, also the catheter, blood in urine, the pain.... Who want to have it done twice?

    • dl0808
      dl0808 JerseyUrology

      Posted

      just wondering if u know what the answer is as to why after aquablation, placing a catheter with a balloon will stop blood flow from blood bleeders generated by aquablation.
    • dl0808
      dl0808 kenneth1955

      Posted

      Ken

      do u have YouTube? If yes, go to YouTube and click search and type in

      nSEhQ4I5YX0

      after viewing , go to search again and type in

      LsMKrOHPKIM

      I can not provide the urls because the moderator will  delete them

    • JerseyUrology
      JerseyUrology jay111

      Posted

       We have done fewer than 10 so far, but so far so good. 
    • dl0808
      dl0808 JerseyUrology

      Posted

      I learned that for Urolift for the first several operations, the company would sent a rep to assist the operation. Just curious if the aquabeam company had done the same thing.
    • kenneth1955
      kenneth1955 dl0808

      Posted

      But I would rather do the Urolift that has 100% no retro and if I need it done again in 4 or 5 years I can have a few more clip heal in 2 weeks and be done for another 4 or 5 year.  no problem  We have had men on here that were thinking the same way.      I will get one surgery and that is it. There is no guarantee that it will work.  A doctor can only tell you what he feel is right for you but he does not know if it will work until it's done. We have had many men that had to have many procedure done  because the one they had did not work or there prostate grew. I would rather have the clips put in  then a knife or laser.  You body can only take so much cutting out before it gives out. But life goes on  Ken    

    • kenneth1955
      kenneth1955 dl0808

      Posted

      I can't get it for some reason that is ok. I did watch a animated one and I think when they showed the picture after they got rid of the whole prostate I think they showed the mountain was still there.  Glad there is a foot pedal and with them not touching the shell of the prostate I guess the nerve bundle is ok but going through all of this for a drop of ejaculation is not worth it.  There has to be a way to save the area where the seminal canal is.  That is one of the question I ask the company and the doctor in Jacksonville Have a good night   Ken

    • jay111
      jay111 JerseyUrology

      Posted

      Dear Dr. JerseyUro- Has enough time passed so that you know how many of the 10 patients ended up with retro, ED, or incontinence..? [Not sure what 'so far, so good' means.] Thanks! - J

    • jay111
      jay111 dl0808

      Posted

      The balloon is placed within the prostate and inflated, thus putting pressure on the prostate which helps to coagulate the area, just like pressure on an external wound.  Cheers- J
    • Camster
      Camster kenneth1955

      Posted

      Kenneth, I like your level of inquisitiveness and detail.  The devil is in the details.  
    • kenneth1955
      kenneth1955 Camster

      Posted

      Thanks Cam I try.  My Urologist tells me I'm a challenge.  He tells me I keep him on his toes.  He's a great guy.  And I trust him But he knows what I will do and not do  God Bless  Ken 

    • kenneth1955
      kenneth1955 dl0808

      Posted

      DL  I just got a second e-mail from a Miss Anderson.  She is the Marketing Manager for BioRobotics  She did say that The surgeon can map out the treatment to avoid key landmarks like the bladder neck or the Veru.  I wonder if it can be program to miss the area where the seminal canal is.  With them saying that I think that they should talk with the patient before the surgery.  The patient should agree to what is being gotten rid off and voice his concerns.  Ken 
    • kenneth1955
      kenneth1955 dl0808

      Posted

      Good afternoon all.  I got a email from a Mr. Neil Barber.  He is a doctor in the UK that is doing the Aquablation   He told me that when they do the procedure they take great care to avoid the Verumontanum and to achieve the maximal relief of the patient they remove about half of the prostate to help remove the obstruction.  The prostate does make up 30 % of the fluid so the fluid volume is cut in half after it is done.  They spare the area of delivery of the common ejaculatory ducts in the prostatic urethra.  But the connection to the seminal canal is lost because of the prostate tissue to open up the bladder neck.   I like what he said on this line I feel this is important.  He said The bladder neck is important for maintaining normal ejaculation should semen be delivered into the prostatic urethra and certainly while this is widely open with aquablation.  I suspect the washing effect rather then thermal cutting mean that there is less damage to the circular fiber there, so more chance of closure during ejaculation.  I think this is good news.  I will let you all know when he get a hold of me He never said if you can change the mapping to save the seminal canal.  Does the patient have a choice of changing the mapping. Take care all  Ken         .
    • kenneth1955
      kenneth1955 dl0808

      Posted

      DL and Friends.  I got another e-mail from Dr. Barbar .  I do not like what he said.  Here goes.  The planning is in real time.  It is done when you are asleep.  You can't identify the prostatic or common ejaculatory ducts.  I'm afraid.  But you can plan to conservative at the bladder neck and were the ducts emerge in the hope for a high rate But that is it.  The patient has no say of what is ablated  He also told me that if I want 100% of sexual and ejaculatory function that should have the UROLIFT done because it is the only one that has no side effects and has good data behind it.  Will what I get out of this is that if you pick to go with the ablation after you sign the papers you have no say in the matter you lose control of the procedure.  For one I do not give total control to any doctor.  It is my body that there doing this to.  It should be talk about with the patients before any tissue is cut.  I am done  Ken      

    • dl0808
      dl0808 kenneth1955

      Posted

      It is amazing that u get dr barbar to return ur email ! He is on all the aquablation trial papers that I am reading.  But I don't completely understand what he said.

      i think what is confusing is the term anejaculation means nothing comes out.  So it excludes partial RE. Thus even if there is just one drop comes out, it does not count towards anejaculation. Thus anejaculation rate can be quite high.

    • kenneth1955
      kenneth1955 dl0808

      Posted

      He sent me 2 e-mail.  That is what he said. And I thanked him for getting back to me I did not like the idea of giving up control.  You have no say of what is being getting rid of it is all done while your out.  To me this is not right.  You should have a consult with the doctor.  Ken
    • dl0808
      dl0808 kenneth1955

      Posted

      I believe the correct and most useful action for the company to do is to publish an official guideline, we will avoid....... Or there are options, if we do this , u  will get his result.. Else u will get different result.
    • kenneth1955
      kenneth1955 dl0808

      Posted

      That is going to be true because the doctor's will have a outline of the procedure but all doctors have there own way of doing things. That is not only with this procedure but with all of them.  The outcome depends on the skill of your doctor I will comment later  Ken

    • dl0808
      dl0808 JerseyUrology

      Posted

      I understand that the latest hemostasis technique being used in aquablation is  "now involves catheter traction for 2 hours following surgery with the balloon of the Foley catheter inflated to 50% of the original prostate volume and positioned in the fossa under TRUS guidance".

      just wondering is this technique also being used by the jersey urology group?

      I would be grateful if you could share this information.

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