Benign Prostatic Hyperplasia (BPH) surgery is evolving not just to simply improve urinary symptoms, but also to include the preservation of sexual function. Moving away from the traditional focus on removing hypertrophied tissue, the clinical paradigm is shifting towards simultaneously considering both voiding function and ejaculatory function.
Amidst this trend, Director Ryu Kyung-ho of Goldman Urology Clinic was invited as a speaker at the 3rd KSER OPEN (Out-patient based Practical ENdourology) Symposium of the Korean Society of Urological Endoscopy and Robotics, held at Cha Bio Complex in Pangyo, Seongnam-si, Gyeonggi-do, and shared his experience with waterjet robotic surgery (Aquablation) in BPH surgery.
The KSER OPEN Symposium is an academic program that addresses practical clinical application experiences and know-how in urological endoscopic surgery. Urologists from across the country attend, discussing practical clinical judgment criteria, focusing on the latest surgical techniques and equipment utilization experiences.
Director Ryu Kyung-ho, under the theme of ‘Aquablation: An Effective and Ejaculation-Preserving Approach’, defined AI-powered waterjet robotic surgery as the next-generation standard for BPH surgery. The core of this approach was a strategy to minimize damage to ejaculatory function while maintaining the effectiveness of improving urinary symptoms.
Waterjet robotic surgery (Aquablation) is a method that simultaneously utilizes real-time transrectal ultrasound (TRUS) and endoscopic images to ablate hypertrophied prostatic tissue with high-pressure water. Director Ryu emphasized that how the depth and extent of ablation are set during this process is a critical variable for preserving ejaculatory function.
Actual clinical cases were also introduced during the lecture.
A male patient in his 50s visited Goldman Urology Clinic after experiencing symptoms of retrograde ejaculation several months after undergoing waterjet robotic surgery at another hospital. Imaging examination results revealed that the ablation area was deeply formed, extending to the region adjacent to the verumontanum, and there was evidence that it had affected the structures surrounding the ejaculatory ducts.
Through this case, Director Ryu explained, "Although the AI waterjet robot is an automated device, if the ablation plan deviates from anatomical standards, there is a risk of functional damage." He particularly pointed out that if the posterior urethral structures of the prostate, which are closely related to ejaculatory function, are not adequately considered, functional side effects can occur independently of improvements in urinary symptoms.
Director Ryu also presented international research findings along with his clinical experience. Waterjet robotic surgery showed the characteristic of not significantly increasing operative time even with an increase in prostate size, and the incidence of retrograde ejaculation (an-ejaculation) was reported to be approximately 11% at the 3-year mark post-surgery. This is a significantly lower figure compared to conventional transurethral resection of the prostate (TURP).
These results suggest that waterjet surgery is not merely a "less invasive surgery," but rather a technique where both functional preservation and symptom improvement can be expected simultaneously, provided there is an accurate understanding of anatomical structures and precise ablation planning.
Director Ryu stated, "In BPH surgery, ejaculatory function outcomes immediately after surgery are as important as the improvement of urinary symptoms." He added, "While waterjet is a tool that allows precise adjustment of the ablation range based on real-time imaging, the final outcome depends on the surgeon's anatomical understanding and judgment."
This lecture holds significance in that it presented a new paradigm for BPH surgery. The message is that a personalized approach is needed, comprehensively considering prostate size, anatomical morphology, and the patient's functional requirements.