Waterjet surgical procedure for enlarged prostate can supply reduction with out compromising sexual enjoyment, trial finds

Utilizing a high-pressure water jet to function on an enlarged prostate can higher protect the flexibility to ejaculate, in contrast with customary laser surgical procedure, finds analysis.

The approach has related outcomes to laser surgical procedure and may be carried out with robotic help, so may cut back ready instances for males with urinary issues attributable to an enlarged prostate.

Preliminary findings of the WATER III trial had been offered on the 2025 European Affiliation of Urology (EAU) Congress in Madrid.

The WATER III trial concerned a water-based surgical process, known as aquablation, at present used for small- and medium-sized prostates. The trial assessed its security and effectiveness to be used with giant prostates, in contrast with surgical procedure utilizing lasers. It additionally investigated opposed uncomfortable side effects similar to erectile dysfunction and urinary incontinence.

The trial was led by researchers from the College of Bonn and concerned sufferers throughout Germany and the UK.

An enlarged prostate, often known as benign prostatic hyperplasia (BPH), is the commonest prostate situation in older males.

The prevalence of BPH will increase with age, affecting over 50% of males aged over 50 and rising to greater than 80% in these aged over 70, with world and regional variations influenced by inhabitants ageing and prostate quantity variations. Whereas non-cancerous, it could possibly trigger urinary issues and considerably impression males’s well being.

Because the prostate gland grows, BPH can squeeze the urethra, resulting in a frequent have to urinate, a weak urine stream, and leaking or dribbling of urine. The place way of life modifications or remedy should not efficient, males can go for surgical procedure. Mostly, this entails utilizing a wire loop or laser to interrupt up and take away the surplus prostate tissue to open up the urethra.

Retrograde ejaculation is a typical aspect impact of BPH surgical procedure. That is the place semen is ejaculated into the bladder, slightly than via the penis. Whereas not a well being threat, retrograde ejaculation can compromise sexual enjoyment and fertility.

Aquablation is a minimally invasive surgical process that makes use of a high-pressure water jet, beneath robotic steering and ultrasound imaging, to find and destroy extra prostate tissue. Commonplace laser surgical procedure for BPH contains Holmium laser prostate surgical procedure (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP), which break up or vaporize extra prostate tissue.

Within the trial, the researchers recruited 202 males who required surgical procedure for his or her BPH. The boys all had giant prostates (between 80–180 mL). Simply over half (98) of sufferers had been assigned to bear aquablation remedy, with the rest (88) assigned to bear both HoLEP or ThuLEP laser surgical procedure.

Throughout a three-month follow-up, males had been assessed for retrograde ejaculation, incontinence and the severity of their decrease urinary tract signs, utilizing the Worldwide Prostate Symptom Rating.

Of the 89 males within the trial who had been sexually lively, retrograde ejaculation was skilled by simply 15% of males within the aquablation group in contrast with over three-quarters of males (77%) within the laser surgical procedure group. Urinary incontinence was reported in 9% of the boys within the aquablation group in contrast with 20% in the usual remedy group. Brief-term symptom enchancment and opposed occasions had been related throughout each teams.

Lead researcher, Professor Manuel Ritter, Head of Urology on the College Hospital Bonn, Germany, mentioned, “Our examine reveals vital promise for aquablation remedy as a substitute for laser-based remedies for males with bigger prostates with BPH.

“Many males settle for their signs as a standard a part of ageing, however after surgical procedure, these sufferers are very pleased to do away with their remedy and signs. Proof that additionally it is efficient at preserving ejaculatory perform brings added advantages for many who want to protect their intercourse lives.”

He continues, “The training curve for surgeons to carry out laser surgical procedure is steep, so the flexibility to supply aquablation to males even with bigger prostates will make remedies extra accessible.”

There are a number of surgical approaches for BPH. The commonest choice, transurethral resection of the prostate (TURP), makes use of a heated wire loop to shave away extra prostate tissue. A earlier five-year trial has proven aquablation can considerably cut back the chance of retrograde ejaculation as a aspect impact in contrast with TURP.

Commenting on the trial, Professor Cosimo De Nunzio, Affiliate Professor of Urology at Sapienza College of Rome, Italy, and Member of the EAU Scientific Congress Workplace, mentioned, “Irregular ejaculation is a really frequent complication following BPH surgical procedure, and so the problem now we have is to strike a steadiness between treating the signs and preserving ejaculation perform.

“Retrograde ejaculation is a specific concern for males who would like to see little to no impression on their intercourse lives following remedy. So, for this group of males, the outcomes of this examine present that aquablation is a really promising choice.

“Nevertheless, the follow-up interval of three months may be very quick and future analysis would wish to incorporate sufferers with persistent urinary retention or urethral catheters, who typically require remedy for BPH.

“Longer-term research would additionally want to incorporate different essential measures, like a discount in prostate-specific antigen within the blood, or an improved urine circulate fee.”