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Treating Enlarged Prostate with Safe, Minimally Invasive Water Jet Ablation

USC Urology offers water jet ablation, a procedure that uses powerful water jets to safely remove unhealthy prostate tissue and does not impact the nearby anatomy tied to urinary control and sexual function.

More than half of American men aged 60 and older experience enlarged prostate glands, also known as benign prostatic hyperplasia (BPH). The condition can obstruct the flow of urine from the bladder, leading to increased frequency and difficulty in urinating.

For one 64-year-old Colorado man, who had been diagnosed with BPH at age 47, the condition eventually resisted medication and caused his prostate to swell to twice the normal size.

In April 2021, after years of managing a frequent need to urinate, he found himself in retention: Though he felt an urgency to use the bathroom, he was unable to urinate.

“My wife raced me to the hospital, where they put in a catheter to drain the urine for seven days,” he said.

After a second incident, he received a urologist’s recommendation to seek a relatively new, minimally invasive procedure known as Aquablation®, or water jet ablation.

In a similar manner as power washing or ultrasonic plaque removal, water jet ablation utilizes the strength of water to safely remove unhealthy prostate tissue, without impacting the nearby anatomy tied to urinary control and sexual function.

In search of the best surgeon in the country to perform the procedure, the Colorado man contacted the technology’s developer.

They referred him to Mihir Desai, MD, a urologist and recognized expert in robotic and minimally invasive surgeries at USC Verdugo Hills Hospital (USC-VHH). According to Dr. Desai, USC Urology at USC-VHH began offering water jet ablation three years ago, making USC-VHH the first West Coast facility to routinely do so, following its involvement in clinical trials. 

“Before the procedure, a detailed map of the prostate is created using an instrument inserted into the urethra and ultrasound imaging, which pinpoint the tissue to be removed,” Dr. Desai said. “Then, a robotic system removes the tissue using a stream of water, which the surgical team can view and control in real time.”

As the only procedure that combines a cystoscope, or camera, with ultrasound imaging, water jet ablation stands out because of its precision, brevity and lack of an incision.

During a 30-minute procedure, surgeons map out the patient’s urethra and prostate and utilize a heat-free water jet — which prevents the risk of thermal injury common with laser surgery — to remove problematic prostate tissue. Most patients spend only one night in the hospital.

Previously, BPH patients often chose between treatment side effects: continued urinary issues or decreased sexual function. The precision of water jet ablation allows surgeons to remove problematic prostate tissue without damaging anatomical structures tied to these functions — a major step forward.

According to Dr. Desai, its success also rates higher than other BPH procedures, meaning that 85% of patients who receive the treatment can expect to regain the urinary function they had 20 years prior, while also avoiding further revision in the short term.

Like other qualified patients, the Colorado man had a significantly enlarged prostate and disrupted urination. Men who regularly take blood thinners are not a good fit, Dr. Desai said, because they could bleed during the procedure.

After receiving water jet ablation at USC Urology at USC-VHH, the Colorado man was able to return to his regular work schedule, which involves frequent cross-country travel.

“I don’t have to go to the bathroom as frequently now,” he said. “I can be in the car for long periods of time, and I don’t need an aisle seat on a plane.”