Benign prostatic hyperplasia (BPH) is a common condition among middle-aged and older men. However, when treatment is delayed, the condition can progress beyond mild inconvenience and begin to affect overall quality of life. When symptoms cannot be adequately controlled with medication or when the prostate becomes significantly enlarged, surgical treatment is often considered. In recent years, however, the criteria patients use to choose a surgical method have begun to change. Rather than focusing solely on symptom relief, many patients now also consider preservation of sexual function when selecting a treatment option.
A Heat-Free Prostate Surgery: The Emergence of Aquablation
One treatment method gaining attention in this changing landscape is robotic waterjet surgery, known as Aquablation. This procedure uses a high-pressure waterjet to selectively remove enlarged prostate tissue. Unlike traditional prostate surgeries that rely on heat-based energy such as lasers or electrocautery, Aquablation minimizes thermal damage to surrounding tissues.
During the procedure, surgeons simultaneously monitor real-time transrectal ultrasound images and endoscopic views while planning the exact resection area. A robotic system then removes prostate tissue precisely within the predefined treatment zone. Because this approach minimizes damage to surrounding normal structures, it may reduce bleeding, postoperative pain, and recovery time for patients.
Even With Advanced Technology, Outcomes Depend on Surgical Strategy
Despite the advanced technology involved, Aquablation should not be viewed as a procedure that automatically guarantees successful results. In real clinical practice, surgical outcomes depend heavily on how the depth and boundaries of the resection are planned.
One particularly important anatomical area is the posterior portion of the prostatic urethra near the verumontanum, which is closely associated with ejaculation function. Precisely identifying and preserving this region plays a crucial role in maintaining postoperative sexual function.
At our institution, a specialized Hood-Sparing Aquablation technique is applied with this principle in mind. This technique focuses on preserving delicate structures related to ejaculation while still improving urinary symptoms. For patients who place a high priority on functional preservation, this approach can serve as a meaningful alternative treatment option.
According to clinical results recently presented at the Korean Urological Association conference, the application of this technique demonstrated approximately twice the rate of sexual function preservation compared with conventional approaches.
Choosing the Right Treatment Requires Multiple Options
At our clinic, multiple treatment options for benign prostatic hyperplasia are available, including Aquablation (robotic waterjet surgery), Rezūm therapy, holmium laser enucleation of the prostate (HoLEP), and prostatic urethral lift (UroLift). Because BPH treatment strategies vary depending on factors such as prostate size, anatomical structure, median lobe enlargement, bleeding risk, and underlying medical conditions, it is important for patients to have access to a variety of treatment options rather than relying on a single technique.
In everyday clinical practice, the most important question is not “Which procedure is the newest?” but rather “Which treatment is most appropriate for this patient?” At our institution, treatment strategies are tailored to each individual patient, including those with large prostates, elderly patients, and those with chronic medical conditions. By offering a range of options such as Aquablation and the Rezūm system, physicians can develop personalized treatment plans based on each patient’s unique clinical situation.
Choosing the Right Hospital for BPH Surgery Is Essential
Today, BPH surgery is no longer focused solely on improving urinary symptoms. Long-term quality of life after surgery has become an equally important consideration. Even when the same surgical technique is used, outcomes can vary depending on how the resection boundaries are planned, how carefully functional structures are preserved, and how well the physician understands the patient’s overall condition.
Ultimately, the success of treatment is determined not by the equipment itself but by how that technology is selected and applied. In BPH treatment, the most important factor is not simply whether the latest technology is available, but whether experienced physicians can apply that technology appropriately for each patient.
For patients considering treatment, it is important to evaluate not only the surgical method but also the clinical principles guiding treatment decisions.
As men age, various urologic conditions can gradually interfere with everyday life. By providing reliable and practical information about urologic health, the goal is to help individuals maintain a healthier and more comfortable life during middle age and beyond.