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

The NHS will offer thousands of men a pioneering procedure that can reduce the size of enlarged prostates with a high-powered water jet.

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

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

It affects approximately three million men in the UK and can make it difficult to urinate and affect sexual function. If left untreated, it can lead to acute urinary retention (where it is impossible to urinate) and infections.

The main function of the prostate is to produce a fluid that, together with sperm, 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 more common in men after age 50.

The new procedure, transurethral water jet ablation, causes fewer complications: research suggests that less than one percent of men are left with continence problems, and it does not cause erectile dysfunction.

While medications can reduce prostate enlargement by up to 30 percent, they are not always successful, and more than 30,000 people each year have to undergo surgery to remove sections that affect urine flow.

However, this operation, called transurethral resection of the prostate or TURP, can cause additional bladder control problems, reduced sexual desire and satisfaction, and erectile dysfunction.

The new procedure, transurethral water jet ablation, causes fewer complications: research suggests that less than one percent of men are left with continence problems, and it does not cause erectile dysfunction.

Patients typically require one night in hospital, compared to two or more for TURP, so health bosses hope it can also help address the two-year backlog in NHS treatment.

Urologist Neil Barber, who works at Frimley Health NHS Foundation Trust in Surrey, has been performing transurethral water jet ablation, also known as aquablation therapy, since 2015. He said: “Men stuck on waiting lists for surgery BPH continually have to be catheterized and admitted to the hospital due to their symptoms, and at the same time use pharmaceuticals that can have serious side effects.

‘During this time, the prostate continues to grow, which affects your quality of life and mental health.

‘For the last 18 months, I have offered aquablation therapy to all my patients. It provides a better solution than TURP and can be performed as an outpatient procedure, meaning more patients can generally be operated on.

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The transurethral water jet ablation operation lasts between 45 minutes and one 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 is located just below the bladder and surrounds the urethra, the tube that carries urine from the bladder out of the body. Another probe is inserted into the urethra and guided to the prostate, where the computer instructs it to fire a high-velocity jet of water at specific areas of the gland.

This removes small amounts of tissue that are suctioned and removed through the probe ports.

“Most patients should be able to leave hospital within 24 hours and some would return home the same day,” Mr Barber said. ‘They will put a catheter in, but it will be removed in 48 hours. Patients may have bleeding from the prostate in the urine and urinary urgency or frequency for a couple of weeks due to inflammation, but this should go away quickly.

“We have a long history of happy, 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 suffering the telltale symptoms: waking up at night wanting to urinate and not feeling like he could fully 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, helping him urinate more easily.

“It worked 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 tests revealed that his prostate had continued to grow. Terry said: ‘I read the letter my consultant wrote to the GP – it said he had a “huge” prostate. In fact, he used the term four times, so I got the message.

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

“Meanwhile, I had to plan trips longer than 45 minutes on public transportation to go through places where I knew there would be a bathroom, because I knew I would have to go.”

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

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

‘As my prostate was very large, they told me I would have to stay hospitalized for two nights.

“When I regained consciousness I didn’t really feel uncomfortable. They removed the catheter before I went home and within a week I was back to normal: I was drinking beer with friends and my sex life was back to normal after about ten days.

‘I’m not taking any medication now. Everything is good. I feel the same as before I started having problems.’