Surgical treatment for benign prostatic hyperplasia (BPH) is evolving beyond simply improving urinary symptoms to also preserving sexual function. The clinical paradigm is shifting from procedures focused solely on removing enlarged tissue toward approaches that consider both urinary function and ejaculation function.
Amid this trend, Dr. Ryu Kyungho of Goldman Urology Clinic was invited as a speaker at the 3rd Korean Society of Endourology and Robotics (KSER) OPEN Symposium, held at the CHA Bio Complex in Pangyo, Seongnam. During the symposium, he shared his clinical experience with robotic waterjet surgery (Aquablation) for the treatment of benign prostatic hyperplasia.
The KSER OPEN Symposium is an academic program that focuses on the practical clinical application of endoscopic urologic surgery. Urologists from across the country attend to discuss real-world clinical decision-making based on the latest surgical techniques and experiences with advanced medical devices.
Dr. Ryu presented under the topic “Aquablation: An Effective and Ejaculation-Preserving Approach,” describing AI-assisted robotic waterjet surgery as a next-generation standard for BPH treatment. The central concept is maintaining effective relief of urinary symptoms while minimizing the risk of damage to ejaculation function.
Robotic waterjet surgery, or Aquablation, removes enlarged prostate tissue using high-pressure water while simultaneously utilizing real-time transrectal ultrasound (TRUS) and endoscopic imaging. Dr. Ryu emphasized that determining the depth and extent of tissue resection is a critical factor in preserving ejaculation function.
During the lecture, he also presented an actual clinical case. A male patient in his 50s visited Goldman Urology Clinic after experiencing retrograde ejaculation several months following robotic waterjet surgery performed at another hospital. Imaging examination revealed that the resection area had extended deeply toward the region near the verumontanum, affecting structures surrounding the ejaculatory ducts.
Using this case as an example, Dr. Ryu explained that although AI-assisted robotic waterjet systems are highly automated, functional complications can still occur if the surgical plan does not adequately reflect anatomical structures. In particular, if the posterior prostatic urethra—which is closely associated with ejaculation function—is not properly considered, functional side effects may occur even when urinary symptoms improve.
Dr. Ryu also introduced findings from international studies alongside his clinical experience. Robotic waterjet surgery has been shown to maintain relatively consistent operative time even in larger prostates. In addition, the rate of anejaculation reported at three years after surgery was approximately 11 percent, which is significantly lower than the rate typically reported with conventional transurethral resection of the prostate (TURP).
These results suggest that robotic waterjet surgery is not simply a procedure that removes less tissue. Rather, when surgical planning is based on accurate anatomical understanding, it can simultaneously achieve symptom relief and functional preservation.
Dr. Ryu noted that in BPH surgery, outcomes related to ejaculation function immediately after the procedure are nearly as important as improvements in urinary symptoms. He explained that while the waterjet system allows precise control of the resection area using real-time imaging, the final outcome ultimately depends on the surgeon’s anatomical understanding and clinical judgment.
This presentation was meaningful in that it highlighted a new paradigm in BPH surgery. The key message was the importance of a personalized approach that takes into account prostate size, anatomical structure, and each patient’s functional expectations when determining the most appropriate treatment strategy.