Interventional procedure overview of transurethral water-jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia

What the procedure involves

Transurethral water-jet ablation for lower urinary tract symptoms caused by BPH uses a specialised system that combines image guidance and robotics for the targeted heat-free removal of prostate tissue. The procedure is usually done with the patient under general or spinal anaesthesia. Transrectal ultrasound is used throughout the procedure. A handpiece with an integrated cystoscope and ablation probe is inserted through the urethra and into the bladder. When the handpiece is correctly positioned, planning software is used to create a personalised treatment plan. A high-speed jet of saline is then delivered to the prostate at various flow rates, to give targeted and controlled tissue removal, according to the treatment plan. The ablated tissue is aspirated through ports in the handpiece and can be used for histological analysis. There are several methods used to control bleeding, including cautery, a balloon catheter in the bladder (with or without bladder neck traction) and a balloon catheter in the prostatic fossa. The average resection time is typically about 3 to 5 minutes. After the procedure, a 3-way Foley catheter is placed through the penis into the urethra and the bladder is continuously irrigated. The catheter is removed before the patient is discharged from hospital, usually the day after the procedure.

The possible advantages of the procedure include a reduction in resection time compared with other endoscopic methods, and the potential to preserve sexual function. The procedure does not use heat to ablate the prostate tissue, which removes the risk of complications arising from thermal injury.