Benign prostatic hyperplasia (BPH) is a common urologic condition among middle-aged and older men. Beyond causing urinary discomfort, it can significantly reduce overall quality of life. Typical symptoms include a weak urinary stream, interrupted urination, a feeling of incomplete bladder emptying, frequent urination, and nighttime urination. Although many people consider these symptoms a natural part of aging and delay seeking treatment, persistent symptoms should prompt a visit to a urology specialist for a thorough evaluation.
The first step in managing BPH is accurate diagnosis. Physicians usually perform a series of assessments including the International Prostate Symptom Score (IPSS), digital rectal examination, prostate-specific antigen (PSA) testing, uroflowmetry, post-void residual urine measurement, and prostate ultrasound. These evaluations help determine the size and condition of the prostate and whether bladder outlet obstruction is present. Based on the results, an individualized treatment plan can be established.
Among the newer treatment approaches, aquablation has recently gained attention. Often referred to as waterjet robotic surgery, this technique removes enlarged prostate tissue using a high-pressure stream of water. Unlike the conventional transurethral resection of the prostate (TURP), aquablation does not rely on heat, which helps minimize damage to surrounding tissues.
Aquablation has received approval from the U.S. Food and Drug Administration (FDA) and has also been recognized as a new medical technology in Korea. Because it involves minimal thermal injury, the risk of complications such as urinary incontinence or erectile dysfunction is considered relatively low. During the procedure, the surgeon first plans the resection area using real-time ultrasound and endoscopic imaging, after which the robotic system precisely removes the targeted tissue. The actual tissue removal stage typically takes about 7 to 15 minutes.
Recently, surgical approaches incorporating the concept of “hood sparing” have also been introduced. This method focuses on preserving anatomical structures around the verumontanum, the area associated with ejaculation. By protecting this region, surgeons aim to reduce the likelihood of sexual side effects such as retrograde ejaculation that can occur after some traditional procedures.
However, no single treatment method is suitable for all patients. The appropriateness of aquablation depends on factors such as prostate size and shape, the severity of bladder outlet obstruction, and the presence of other medical conditions. In addition, some patients may temporarily experience frequent urination or changes in their voiding pattern after surgery, making regular follow-up important.
Specialists emphasize that the experience and skill of the surgeon are crucial. Because aquablation relies on robotic systems and imaging technology for precise tissue removal, a surgeon’s ability to understand prostate anatomy and carefully design the surgical plan plays a major role in determining treatment outcomes.
Dr. Lee Chang-gi of Goldman Urology Clinic’s Incheon branch noted that patients considering BPH treatment should not choose a procedure based solely on its name. Instead, they should also evaluate the physician’s experience and level of expertise. He added that when advanced medical technology is combined with extensive clinical experience, patients can expect safer procedures and more satisfactory treatment outcomes.