Waterjet Prostate Ablation
Waterjet Prostate Ablation
Introduction Men with enlarged prostates commonly experience lower urinary tract symptoms and
 may go on to develop complications such as acute urinary retention (AUR). Surgery is the
 standard treatment option required to remove the enlarged prostates and to rectify such
 complications.

 Transurethral resection of prostate (TURP) was first performed over 80 years ago and is still
 regarded as the "gold standard" for the treatment of benign prostatic enlargement (BPE) in
 prostates between 30 and 80ml. While TURP results in an improvement in symptoms,
 perioperative morbidity and long-term complications can include postoperative bleeding,
 urinary retention, incontinence, urethral strictures, erectile dysfunction, and ejaculatory
 dysfunction. Aquablation, a novel minimally invasive water ablation therapy combining image
 guidance and robotics (AQUABEAM®, Procept BioRobotics, Redwood Shores, CA, USA) for the
 targeted and heatfree removal of prostate tissue is one of the efforts in the development of
 new technology in recent years to replicate the effectiveness of TURP and at the same time
 with an improved safety profile. In this study, investigators plan to evaluate the
 feasibility and safety of Aquablation in the management of AUR secondary to BPE.

 Method 20 participants are expected in this study. After patients consent to participate in
 the study, they will go through Aquablation under general anaesthesia or spinal anaesthesia.
 The ablation is delivered by transurethral means. After the procedure, subject is expected to
 go home on the following day. Subject will be assessed 3 months and 6 months after the
 procedure. Follow-up assessment includes blood tests, prostate ultrasound and urodynamic
 study.
Benign prostatic enlargement (BPE) is a non-malignant growth of the prostate gland that can
 lead to a range of lower urinary tract symptoms (LUTS), and in some cases eventually leading
 to retention of urine. In patients failing to wean off catheter after retention of urine due
 to BPE, surgical intervention is the standard treatment.

 Surgical intervention options have evolved from electrosurgical resection to the use of
 lasers for enucleation and ablation. Transurethral resection of prostate (TURP) was first
 performed over 80 years ago and is still regarded as the "gold standard" for the treatment of
 BPE in prostates between 30 and 80ml. While TURP results in a statistically significant
 improvement in symptoms score and and maximum urinary flow rate (Qmax), perioperative
 morbidity and long-term complications can include postoperative bleeding, urinary retention,
 incontinence, urethral strictures, erectile dysfunction, and ejaculatory dysfunction.
 Aquablation, a novel minimally invasive water ablation therapy combining image guidance and
 robotics (AQUABEAM®, Procept BioRobotics, Redwood Shores, CA, USA) for the targeted and
 heat-free removal of prostate tissue is one of the efforts in the development of new
 technology in recent years to replicate the effectiveness of TURP and at the same time with
 an improved safety profile. Safety and feasibility of Aquablation in the management of benign
 prostatic hyperplasia (BPH) have been proven successful in both canine model and human. Since
 then, two other prospective non-randomized trials demonstrated that the surgical ablation of
 the prostate using Aquablation had achieved significant and immediate improvement of
 functional voiding parameters as well as symptomatic improvement. Two randomized controlled
 trials comparing Aquablation against TURP found that Aquablation had produced a similar
 improvement in LUTS as TURP, with a better side-effect profile. AQUABEAM® is currently a FDA
 approved equipment for the ablation of prostate tissue. It is being used in US as well as in
 Europe and New Zealand.

 So far, all studies focused on the application of Aquablation in patients with LUTS only
 secondary to benign prostatic obstruction (BPO). In this study, investigators plan to
 evaluate the feasibility and safety of Aquablation in the management of another facet of BPH,
 which is retention of urine.
Inclusion Criteria:

 -  Retention of urine refractory to medical treatment

 Exclusion Criteria:

 -  Patients with active urinary tract infection

 -  Patients with bleeding disorder or on anti-coagulation

 -  Patients with bladder pathology including bladder stone and bladder cancer

 -  Patients with urethral stricture

 -  Patients with neurogenic bladder and/or sphincter abnormalities

 -  Patients with previous nonpharmacological prostate treatment,

 -  Prostate cancer

 -  Fail to give informed consent