Water Jet Procedure Offers Quick, Effective Way to Treat Enlarged Prostate at USC-VHH

Mihir Desai, MD

As men age, most will develop an enlarged prostate, a condition known as benign prostatic hyperplasia, or BPH. Although BPH is noncancerous, it can block the bladder’s outflow and lead to problems with urination.

BPH medications can be effective for some men, but other patients may need surgical intervention. USC Verdugo Hills Hospital, a part of Keck Medicine of USC, offers one of the most advanced treatments for BPH – a minimally invasive procedure that uses water to reduce the size of the prostate.

Water jet ablation, also known as Aquablation®, is a novel treatment that combines a robotically controlled stream of water with advanced image guidance technology to safely remove the desired amount of prostate tissue to unblock the urethra. This treatment requires no skin incisions and patients typically do not experience any of the unwanted side effects of open prostate surgery, which can include incontinence and sexual dysfunction.

“This technology is quicker and safer and it also gives us the ability to treat a [higher] number of patients,” said Mihir Desai, MD, director of the USC Urology’s Center for Advanced Robotics. In the past, men who had very enlarged prostates or those with difficult anatomic configurations often could not be treated using purely endoscopic techniques.

Because water jet ablation is performed under regional anesthesia, the procedure is easier on the patient and can be a viable option for older men who may be too frail to have traditional surgery under general anesthesia, Desai said.

The first step in water jet ablation is to create a detailed map of the prostate using both a cystoscope and ultrasound imaging. This map pinpoints the tissue that must be removed and helps the surgeon avoid the areas of the prostate that may lead to incontinence or sexual dysfunction.

Then a robotic system removes the tissue using a stream of water while specialized ultrasound imaging allows the team to view the prostate in real time. The water is unheated, which reduces the risk of damage to surrounding tissue and minimizes the risk of unwanted side effects.

The procedure typically takes only a few minutes, but most patients spend one night in the hospital and return home the next day without a catheter.

The team of urologists at USC Urology was the first to offer water jet ablation on the West Coast about three years ago, according to Desai. The team also ran much of the preclinical and clinical testing of the device and continues to conduct research on the procedure.

“We have been involved with this new technology from the very beginning,” said Desai, adding that the urologists at Keck Medicine are among the most experienced group of surgeons in the nation.

“We have a wealth of experience, and we are now one of the largest volume centers for Aquablation® in the country,” he said.