Benign Prostatic Hyperplasia (BPH) is considered a common urological abnormality found in men after their 50s. It is characterized by causing various uncomfortable symptoms such as difficulty urinating, persistent feeling of residual urine, and nocturia. Although traditional transurethral resection of the prostate (TURP) has been the standard treatment for a long time, the results varied depending on the medical staff's skill level and the size of the prostate. Furthermore, many patients felt burdened by the risks of complications such as erectile dysfunction, retrograde ejaculation, and urinary incontinence.
On the other hand, the recently introduced 'Aquablation (robotic waterjet surgery)' is being widely implemented as a treatment method that compensates for these drawbacks. Aquablation is a method of cutting prostate tissue using a high-pressure waterjet. Since it does not generate heat during this process, damage to surrounding tissues can be minimized.
When the surgeon precisely plans the resection area through ultrasound and endoscopy before Aquablation surgery, the robot removes the designated area accurately and consistently. This process typically takes as little as 7 to 15 minutes, and since same-day discharge is possible, it significantly reduces the burden of recovery for patients. In particular, the risk of urethral stricture or bladder neck contracture is low, and positive improvement results can be expected in that the effect of improving voiding function is excellent.
However, being a new treatment method doesn't mean it's suitable for all patients unconditionally. First, an assessment of individual patient suitability is necessary. Factors such as the size and shape of the prostate, comorbid diseases, and the possibility of anesthesia must be considered. Especially for elderly patients or those with underlying medical conditions such as cardiovascular disease, a more cautious approach is needed.
Second, post-operative management is also important. In the initial stage, symptoms such as frequent urination or changes in voiding patterns may appear, but these generally recover over time. In addition, regular follow-up and consultation with medical staff are necessary.
Third is the selection of highly skilled medical staff. Although robotic technology increases the accuracy and consistency of surgery, it is still the role of the medical staff to actually plan the surgery, check for hemostasis, and manage the patient's overall condition. Therefore, choosing experienced medical staff is a key factor in increasing safety and satisfaction.
Fourth is identifying whether sexual function is preserved after surgery. In the case of existing surgical methods, retrograde ejaculation, where semen is not discharged along the urethra but flows back toward the bladder, could occur during the process of widely resecting enlarged prostate tissue. A treatment strategy that has recently been gaining attention to overcome such limitations is 'Hood Sparing (preserving the verumontanum tissue)' Aquablation. The core is protecting the anatomical structures directly related to ejaculatory function by applying the 'Hood Sparing' concept to the Aquablation process. The 'Hood' in the Hood Sparing technique refers to the structure around the verumontanum, which is the entrance where ejaculation begins.
Director Ryu Kyeong-ho of Goldman Urology Gangnam Branch said, "Aquablation can be an innovative treatment alternative for BPH patients with a lower risk of complications, faster recovery, and no regional constraints on the size of the prostate compared to conventional surgical methods." He added, "However, a tailored treatment decision that fits the individual patient's situation is required. True effects can be expected when sufficient consultation before treatment and steady management after surgery are accompanied, and medical expertise, patient understanding, and cooperation must be supported together."