Benign prostatic hyperplasia (BPH) is a common urologic condition frequently found in men over the age of 50. It is characterized by symptoms such as difficulty urinating, persistent sensation of incomplete bladder emptying, and frequent nighttime urination. Traditional prostate resection surgery has long been considered the standard treatment, but outcomes can vary depending on the surgeon’s experience and the size of the prostate. In addition, potential complications such as erectile dysfunction, retrograde ejaculation, and urinary incontinence have caused many patients to feel hesitant about undergoing surgery.
In contrast, a newer treatment method known as Aquablation (robotic waterjet surgery) has recently been introduced and is increasingly used to address these limitations. Aquablation removes enlarged prostate tissue using a high-pressure waterjet. Because the procedure does not generate heat, it helps minimize damage to surrounding tissues.
Before the surgery, the operating physician carefully plans the resection area using ultrasound and endoscopic imaging. The robotic system then removes only the designated tissue with high precision and consistency. The procedure typically takes about 7 to 15 minutes and, in some cases, allows for same-day discharge, significantly reducing the burden of recovery for patients. It is also associated with a lower risk of urethral stricture or bladder neck contracture and has demonstrated strong effectiveness in improving urinary function.
However, even though it is a newer treatment method, Aquablation is not automatically suitable for every patient. First, individual patient suitability must be evaluated. Factors such as prostate size and shape, accompanying medical conditions, and the patient’s ability to undergo anesthesia must be considered. This is particularly important for elderly patients or those with underlying cardiovascular diseases.
Second, postoperative care is also important. During the early recovery period, patients may experience symptoms such as frequent urination or temporary changes in urinary patterns, but these symptoms generally improve over time. Regular follow-up evaluations and consultations with medical professionals are recommended.
Third, selecting a highly experienced medical team is crucial. While robotic technology improves surgical precision and consistency, planning the procedure, confirming hemostasis, and managing the patient’s overall condition remain the responsibility of the physician. Therefore, choosing a surgeon with extensive experience is a key factor in ensuring safety and patient satisfaction.
Fourth, the preservation of sexual function after surgery should also be considered. In conventional surgical methods, extensive removal of enlarged prostate tissue can sometimes lead to retrograde ejaculation, in which semen flows backward into the bladder instead of exiting through the urethra. To address this limitation, a newer strategy known as Hood Sparing Aquablation has gained attention. This technique applies the “Hood Sparing” concept during Aquablation to preserve anatomical structures directly associated with ejaculation function. In this context, the “hood” refers to the structures surrounding the verumontanum, the area where ejaculation begins.
Dr. Ryu Kyung-ho of Goldman Urology Clinic Gangnam Branch explained that Aquablation can serve as an innovative treatment alternative for patients with benign prostatic hyperplasia, offering lower complication risks, faster recovery, and effectiveness regardless of prostate size compared with traditional surgical methods. However, he emphasized that treatment decisions must be tailored to each patient’s individual condition. Adequate consultation before treatment and consistent postoperative care are essential for achieving optimal outcomes, supported by both the expertise of medical professionals and the patient’s understanding and cooperation.