A blast of water could shrink an enlarged prostate as effectively as surgery, but with fewer side-effects, a new trial suggests.
The probe-like device, which fires a high-speed jet of salt water at the gland to remove excess tissue, works in minutes and has a four-fold lower risk of sexual complications, compared with surgery, say researchers from Frimley Park Hospital in Surrey and other centres.
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate, a walnut-sized gland below the bladder. Its main job is to make fluid for semen.
The cause of the condition — which affects around half of men in their 50s and up to 90 per cent of those over 80 — is not fully understood, though one theory is that, as men age, their testosterone levels drop, triggering the growth of prostate cells.
Progress: The AquaBeam water jet system fires a saline solution at the prostate from a tube-like device that is fed through the urethra and into the bladder, guided by ultrasound images +2
Progress: The AquaBeam water jet system fires a saline solution at the prostate from a tube-like device that is fed through the urethra and into the bladder, guided by ultrasound images
Not all affected men will have symptoms. However, an enlarged prostate can compress the urethra, the tube that carries urine from the body, causing frequent trips to the loo, a weak urine stream and a feeling of not fully emptying the bladder.
Mild symptoms are usually treated with medicines such as alpha blockers, which relax the muscle of the prostate and bladder neck, allowing urine to flow more easily.
If medication doesn’t work, then surgery is an option — transurethral resection of the prostate (TURP), which removes excess tissue, is considered the gold standard, but is invasive and can lead to erectile dysfunction or incontinence.
To try to avoid these side-effects, techniques less likely to damage healthy tissue are being investigated. The AquaBeam water jet system fires a saline solution at the prostate from a tube-like device that is fed through the urethra and into the bladder, guided by ultrasound images.
Destroyed tissue is suctioned out and removed via holes in the device. The procedure is usually carried out without a general or spinal anaesthetic.
A trial on around 200 patients comparing the procedure with TURP, reported in the journal Advances In Therapy, found it was highly effective.
Two years after the treatment, nine out of ten men in both groups had a significant improvement in their symptoms.
However, those who’d received the water jet had better urine flow: this increased from below 5ml per second to about 11ml per second in this group, compared with an improvement to 9ml per second in the TURP group.
There were also fewer sexual side-effects in the water jet group. Among sexually active men, anejaculation (an inability to ejaculate semen) was less common in the water jet group — 10 per cent, compared with 36 per cent in the surgery group.
Professor Raj Persad, a consultant urologist at Bristol Urology Associates, says: ‘TURP is fraught with potential complications.
‘But minimally invasive procedures such as this can often be done as a day case and even under local anaesthetic.’
1 July 2019