Waterjet Surgery for Enlarged Prostate: Study Finds It Effective Relief Without Impacting Sexual Well-Being
Using a high-pressure water jet to operate on an enlarged prostate can better preserve the ability to ejaculate, compared with standard laser surgery, finds research. The technique has similar outcomes to laser surgery and can be performed with robot assistance, so could reduce waiting times for men with urinary problems caused by an enlarged prostate.
The WATER III trial involved a water-based surgical procedure, called Aquablation, currently used for small- and medium-sized prostates. The trial assessed its safety and effectiveness for use with large prostates, compared with surgery using lasers. It also investigated adverse side effects such as erectile dysfunction and urinary incontinence.
An enlarged prostate, known as Benign Prostatic Hyperplasia (BPH), is the most common prostate condition in older men. The prevalence of BPH increases with age, affecting over 50% of men aged over 50 and rising to more than 80% in those aged over 70, with global and regional variations influenced by population aging and prostate volume differences. While non-cancerous, it can cause urinary problems and significantly impact men’s health. As the prostate gland grows, BPH can squeeze the urethra leading to a frequent need to urinate, a weak urine stream, and leaking or dribbling of urine. Where lifestyle changes or medication are not effective, men can opt for surgery. Most commonly, this involves using a wire loop or laser to break up and remove the excess prostate tissue to open up the urethra.
In the trial, the researchers recruited 202 men who required surgery for their BPH. The men all had large prostates (between 80 – 180 mL). Just over half (98) of patients were assigned to undergo aquablation therapy, with the remainder (88) assigned to undergo either HoLEP or ThuLEP laser surgery.
Of the 89 men in the trial who were sexually active, retrograde ejaculation was experienced by just 15% of men in the aquablation group compared with over three-quarters of men (77%) in the laser surgery group. Urinary incontinence was reported in 9% of the men in the aquablation group compared with 20% in the standard treatment group. Short-term symptom improvement and adverse events were similar across both groups.
Hence, they concluded that the learning curve for surgeons to perform laser surgery is steep, so the ability to offer aquablation to men even with larger prostates will make treatments more accessible
Ref: WATER III trial presented at the 2025 European Association of Urology (EAU) Congress, Madrid
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