Name of the Procedure:

Transurethral Waterjet Ablation of Prostate (TWAP), also known as Aquablation Therapy

Summary

Transurethral Waterjet Ablation of the Prostate is a minimally invasive surgical procedure used to treat an enlarged prostate. It uses high-pressure water jets, guided by ultrasound, to remove excess prostate tissue. This procedure includes control of post-operative bleeding. Other included minor procedures are vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy.

Purpose

The procedure addresses benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged, causing urinary problems. The goals are to reduce urinary symptoms, improve urine flow, and decrease bladder obstruction.

Indications

• Difficulty in urinating
• Frequent urination, especially at night
• Urgency to urinate
• Weak urine stream or stream that stops and starts
• Inability to completely empty the bladder

Patient criteria:

• Diagnosis of benign prostatic hyperplasia (BPH)
• Moderate to severe urinary symptoms affecting the quality of life
• Considered suitable for minimally invasive intervention

Preparation

• Patients may be required to fast for 6-8 hours before the procedure.
• Medication adjustments might be necessary, especially blood thinners.
• Pre-operative assessments, including blood tests, urine tests, and prostate ultrasound.

Procedure Description

1. Patient is placed under general or spinal anesthesia.
2. A cystoscope (a thin tube with a camera) is inserted through the urethra to visualize the prostate.
3. Ultrasound guidance is used to map the prostate.
4. High-pressure waterjets are directed at the prostate tissue to remove the excess parts.
5. Control of post-operative bleeding is managed through direct visualization and intervention.
6. Additional procedures such as vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are performed if necessary.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital or surgical center, typically in an outpatient setting.

Personnel

• Urologist or urological surgeon
• Anesthesiologist
• Surgical nurses
• Ultrasound technician

Risks and Complications

Common risks:

• Bleeding
• Infection
• Temporary difficulty in urinating Rare risks:
• Injury to the urethra or bladder
• Urinary incontinence
• Erectile dysfunction Complications are generally managed with medical or surgical intervention.

Benefits

• Significant improvement in urinary symptoms
• Minimized risk of sexual dysfunction compared to traditional surgery
• Quick recovery times
• Usually, noticeable improvement within a few weeks.

Recovery

• Hospital stay of 1-2 days, or outpatient discharge in some cases
• Temporary urinary catheter may be needed for 1-3 days.
• Avoid strenuous activities for a couple of weeks.
• Follow-up appointments to monitor recovery and symptom improvement.

Alternatives

• Medication management with alpha-blockers or 5-alpha-reductase inhibitors.
• Other surgical options like Transurethral Resection of the Prostate (TURP), laser therapy. Pros and cons:
• Medications have fewer immediate risks but can be less effective in severe cases.
• TURP and laser therapy are more invasive but effective, with different risk profiles.

Patient Experience

• The procedure is typically well-tolerated under anesthesia.
• Some mild discomfort or mild pain post-procedure, managed with pain medication.
• Minimal blood in urine for up to a few days.
• Improvement in urinary symptoms is usually observed within a few weeks to months.