Benign prostatic hyperplasia (BPH) is a condition in which the prostate enlarges and compresses the urethra, leading to various urinary problems. It commonly occurs in middle-aged and older men and is closely associated with aging.
Typical symptoms of BPH include a weak urinary stream, interrupted urination, a sensation of incomplete bladder emptying, and frequent urination. According to data from the Health Insurance Review and Assessment Service, the number of patients with BPH has been steadily increasing as society enters a super-aging phase. As a result, demand for effective and safe treatment options is also rising.
Diagnosis of BPH involves several examinations. Physicians typically begin with a medical interview to review the patient’s past medical history and current medications. The severity of urinary symptoms is then assessed using the International Prostate Symptom Score (IPSS), a globally standardized questionnaire. This is followed by a physical examination and a digital rectal examination to evaluate the size of the prostate and check for nodules. Additional tests may include urinalysis to detect hematuria or urinary tract infection and prostate-specific antigen (PSA) testing to assess the possibility of prostate cancer.
Uroflowmetry and post-void residual urine measurements are also performed to evaluate urinary flow rate and the amount of urine remaining in the bladder after urination. If necessary, cystoscopy may be conducted to visually examine the bladder and urethra. Urodynamic studies and UroCuff testing can help determine the exact cause of urinary symptoms. In addition, transrectal ultrasound is used to assess prostate size and identify any abnormalities. Based on these findings, physicians can develop a personalized treatment plan for each patient.
One treatment option that has gained attention in recent years is aquablation, often referred to as waterjet robotic surgery. This technique removes enlarged prostate tissue using a high-pressure water stream, allowing precise tissue removal without causing thermal damage. 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, demonstrating both safety and effectiveness. Unlike traditional transurethral resection of the prostate (TURP), aquablation does not rely on heat, which helps minimize damage to surrounding healthy tissue.
During aquablation surgery, the treatment area is identified in real time using ultrasound and endoscopic imaging, while a robotic system precisely removes the targeted prostate tissue. Because the procedure relies on both advanced technology and careful surgical planning, the surgeon’s experience and ability to design the resection area accurately play an important role in achieving successful outcomes.
Robotic-assisted procedures require a high level of technical precision and rapid decision-making. Surgeons must continuously monitor the prostate’s anatomical structure using ultrasound and endoscopic images while carefully controlling the robotic system. This process demands considerable expertise and concentration to minimize potential errors and respond appropriately to unexpected situations.
In addition, each patient with BPH may have different characteristics, including variations in prostate size, shape, degree of bladder outlet obstruction, and the presence of complications. For this reason, physicians must evaluate each patient individually and develop a tailored treatment plan.
Dr. Kim Jae-woong of Goldman Urology Clinic’s Gangnam branch explained that the greatest advantage of aquablation is that it does not use heat, which significantly reduces the risk of damage to surrounding tissues and lowers the likelihood of complications such as urinary incontinence or erectile dysfunction that can occur with some traditional surgical methods. However, he emphasized that even with advanced medical devices, successful surgical outcomes ultimately depend on the surgeon’s level of expertise and experience.