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Utilizing a high-pressure water jet to function on an enlarged prostate can higher protect the power to ejaculate, in contrast with customary laser surgical procedure, finds analysis.
The method has comparable outcomes to laser surgical procedure and will be carried out with robotic help, so might cut back ready instances for males with urinary issues attributable to an enlarged prostate.
Preliminary findings of the WATER III trial have been introduced 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 adversarial negative effects corresponding 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 most typical 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 getting older and prostate quantity variations. Whereas non-cancerous, it will possibly trigger urinary issues and considerably affect males’s well being.
Because the prostate gland grows, BPH can squeeze the urethra, resulting in a frequent must urinate, a weak urine stream, and leaking or dribbling of urine. The place way of life modifications or medicine 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 standard facet impact of BPH surgical procedure. That is the place semen is ejaculated into the bladder, relatively than by 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, underneath robotic steering and ultrasound imaging, to find and destroy extra prostate tissue. Normal laser surgical procedure for BPH consists of 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 have been assigned to endure aquablation remedy, with the rest (88) assigned to endure both HoLEP or ThuLEP laser surgical procedure.
Throughout a three-month follow-up, males have 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 have 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 therapy group. Brief-term symptom enchancment and adversarial occasions have been comparable throughout each teams.
Lead researcher, Professor Manuel Ritter, Head of Urology on the College Hospital Bonn, Germany, mentioned, “Our examine reveals important promise for aquablation remedy as a substitute for laser-based therapies for males with bigger prostates with BPH.
“Many men accept their symptoms as a normal part of aging, but after surgery, these patients are very happy to get rid of their medication and symptoms. Evidence that it is also effective at preserving ejaculatory function brings added benefits for those who wish to preserve their sex lives.”
He continues, “The learning curve for surgeons to perform laser surgery is steep, so the ability to offer aquablation to men even with larger prostates will make treatments more accessible.”
There are a number of surgical approaches for BPH. The commonest possibility, 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 danger of retrograde ejaculation as a facet 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 we have now is to strike a stability between treating the signs and preserving ejaculation operate.
“Retrograde ejaculation is a specific concern for males who would favor to see little to no affect on their intercourse lives following therapy. So, for this group of males, the outcomes of this examine present that aquablation is a really promising possibility.
“Nonetheless, the follow-up interval of three months could be very brief and future analysis would wish to incorporate sufferers with power urinary retention or urethral catheters, who typically require therapy for BPH.
“Longer-term studies would also need to include other important measures, like a reduction in prostate-specific antigen in the blood, or an improved urine flow rate.”
Supplied by
European Affiliation of Urology
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Waterjet surgical procedure for enlarged prostate can supply aid with out compromising sexual enjoyment, trial finds (2025, March 21)
retrieved 21 March 2025
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