Water-jet procedure to shrink enlarged prostates will be offered to thousands of male patients as routine treatment on the NHS

A groundbreaking procedure that can reduce enlarged prostates with a powerful jet of water will be offered to thousands of men by the NHS.

While the operation, called transurethral waterjet ablation, has been available in limited circumstances for five years, the health watchdog, the National Institute for Health and Care Excellence (NICE), has now recommended that doctors in England offer it as the first-line treatment for enlarged problems. prostate.

The condition, also known as benign prostatic hyperplasia (BPH), causes the prostate gland to grow, putting pressure on the bladder and urethra.

It affects around three million men in Britain and can make it difficult to urinate and affect sexual function. If left untreated, it can lead to acute urinary retention – where urination is impossible – and infections.

The main function of the prostate is to produce a fluid that, together with sperm cells, forms semen. The actual cause of prostate enlargement is unknown, but problems related to aging and changes in testosterone levels may be a factor. It is most common in men after the age of 50.

The new procedure, transurethral water jet ablation, causes fewer complications – research shows that less than one percent of men have continence problems and it does not cause erectile dysfunction

Although medication can reduce an enlarged prostate by as much as 30 percent, this is not always successful. More than 30,000 people each year need surgery to remove the sections that affect urine flow.

However, this surgery, called transurethral resection of the prostate or TURP, can lead to additional problems with bladder control, a reduction in sexual drive and satisfaction, and erectile dysfunction.

The new procedure, transurethral water jet ablation, causes fewer complications. Research shows that less than one percent of men have continence problems and that it does not cause erectile dysfunction.

Patients generally require one night in hospital, compared to two or more for TURP, so health chiefs hope this could also help tackle the two-year NHS backlog for treatment.

Urologist Neil Barber, based at Frimley Health NHS Foundation Trust in Surrey, has been performing transurethral waterjet ablation, also known as aquablation therapy, since 2015. He said: ‘Men on waiting lists for BPH surgery are constantly required to be catheterised and admitted to hospital due to their symptoms, while also taking medicines that can have serious side effects.

‘During this time the prostate continues to grow, impacting their quality of life and mental health.

‘Over the past 18 months, all my patients have been offered aquablation therapy. It offers a better solution than TURP and can be performed as a day procedure, meaning that more patients can be operated on in total.’

The transurethral water jet ablation takes 45 minutes to an hour, usually under general or spinal anesthesia.

First, the surgeon will plan the procedure using an ultrasound probe placed in the rectum and next to the prostate. This allows the patient’s exact anatomy to be scanned and stored on a computer

The prostate gland is located just below the bladder and wraps around the urethra – the tube that carries urine from the bladder and out of the body. Another probe is inserted into the urethra and guided to the prostate, where the computer instructs it to shoot a high-speed jet of water at specific parts of the gland. This flushes out small amounts of tissue that are suctioned and removed through ports in the probe.

“Most patients should be able to leave the hospital within 24 hours, and some can return home the same day,” Barber said. ‘They are given a catheter, but it is removed within 48 hours. Patients may experience bleeding from the prostate in their urine for a few weeks due to inflammation, and urgency or frequency of urination, but this should disappear quickly.

‘We have a long history of happy and satisfied patients whose lives have been transformed by aquablation treatment.’

One man who has benefited from the procedure is Terry Smith, 69, a retired IT project manager from London. The father of four was diagnosed with BPH in 2018 after experiencing the telltale symptoms of waking up during the night because he needed to urinate and not feeling like he could completely empty his bladder.

After tests revealed the cause of his problems, he was prescribed tamsulosin – a common treatment for BPH that works by relaxing the muscles around the bladder and prostate, making urination easier.

“It helped almost immediately,” Terry said.

‘I started sleeping better and regained a reasonable quality of life, but a few years later I started noticing blood in my urine.’

Further examination revealed that his prostate had continued to grow. Terry said: ‘I read the letter my consultant wrote to the GP saying I had a “large” prostate. He even used the term four times, so I got the message.

‘I was told I needed a procedure to reduce its size, but it would be a long wait. The clinic said they couldn’t even give me a date and that I would be put on a waiting list.

‘Meanwhile, I had to plan trips longer than 45 minutes on public transport to go to places where I knew there would be a toilet because I knew I had to go there.’

Since he had health insurance, Terry decided to go private, and he had the surgery in September 2022.

“I started doing some research and that’s when I discovered aquablation,” he said. ‘The media reports I read were encouraging, as it seemed less likely that the TURP procedure would cause me any problems afterwards.

‘Because my prostate was very large I was told I had to stay for two nights.

‘When I came to, I didn’t really have any problems. Before I went home, I had my catheter taken out and within a week I was back to normal – drinking beer with friends and my sex life was back to normal after about ten days.

‘I don’t take any medication now. Everything is good. I feel just like I did before I got in trouble.”