If you’re a mature male, you might have experienced some or all of the following difficulties: Your urine stream slows to a trickle. You feel the need to strain when you go. When you do have to go, you have to go right now. You wake several times in the night to go to the bathroom. It may feel like your bladder hasn’t completely emptied.

 A likely culprit? Benign prostatic hyperplasia, or BPH. Translated into English: a swollen prostate. 

Medical professionals have many ways to treat BPH, from simple lifestyle changes to medication to surgical procedures. Now, doctors at Temple Health – Chestnut Hill Hospital offer a new minimally invasive approach to restoring normal urine flow. It’s called Aquablation, a procedure that urologist Steve Sterious, M.D., performs. 

The prostate is a gland seated deep within the pelvis and below the bladder and produces fluid that combines with sperm to make semen. Urine passes from the bladder into the urethra, which is encircled by the prostate. According to Serious, the prostate is about the size of a walnut in most younger men. However, it generally grows larger as men age. 

“A lot of it is genetics,” Sterious says, “but for each decade of life, as men get older, the chances that you will have BPH goes up on average 10 or 15 percent. If you were to live to be 100, there’s a hundred percent chance that you’re going to have some form of BPH.”

As the prostate grows, he says, it can compress the urethra, reducing urine flow. It can also grow into the bladder and cause more problems. 

Enter Aquablation, an incision-less, minimally invasive robotic procedure, performed under general anesthesia, that employs a heat-free water jet to remove prostate tissue and open the channel around the urethra. Ultrasound imaging helps the surgeon plan and map out what areas of the prostate that will be resected (cut away) based on the individual anatomy of each patient – because every patient’s prostate is different. The procedure takes about an hour.

“Then the robot will do that resection with the water jet,” says Dr. Sterious. “That’s unique to that type of surgery compared to other ones. General anesthesia is required because you can’t move because of the planning required. If the patient were to move, it would mess up everything, and we’d have to re-plan. With most of the Aquablation procedures we perform here, you stay overnight and the next day you go home, with or without a catheter (which might be required as the prostate heals).”

Unlike other minimally invasive surgical therapies, such as Urolift  (using implants to move the prostate tissue away from the urethra), HoLEP (laser surgery to remove prostate tissue) or Rezum (which uses steam to help shrink the prostate over time), there’s a lower probability that you might need additional therapy or surgery in the future. “The five-year data show about a 6 percent chance that you would need some kind of medicine or surgery (following Aquablation),” Dr. Sterious says. 

There are other benefits, aside from restoring normal urine flow, says Dr. Sterious. There’s a low rate of erectile dysfunction and incontinence. As with all surgical procedures, minimally invasive or otherwise, there are risks. Patients might need a catheter temporarily. There could be catheter bleeding. These, Dr. Sterious says, are low risks. 

This doesn’t mean you can march into the urologist’s office and say to the doctor, give me Aquablation. As we said at the beginning, Aquablation is just one of many approaches urologists can use to address BPH. Which approach is best is dictated in part by a medical assessment. A thorough workup will help define the size and shape of the prostate, establish how well the patient is emptying his bladder, assess his kidney function, and determine his PSA test levels by performing a blood test. (PSA stands for prostate-specific antigen, which can be an indicator of prostate cancer.)

Which treatment path to follow is also, to a significant degree, guided by the patient.

“For many patients, at least the way I view it, it’s having a conversation about the degree of bother,” says urologist Justin Friedlander, M.D., who works with Dr. Sterious. “We have symptom scores that we can review with the patient. We usually have them fill out the score every time we see them, especially the first time. So, we see where they fall on the symptom index. That gives patients an opportunity to reflect on how bothersome or severe their symptoms are or not. Our recommendations tend to stem from the degree of bother or the severity of their symptoms. Each patient is unique.”

Urologic services at Chestnut Hill are part of a broader Fox Chase Cancer Center-Temple Health initiative, the new Fox Chase-Temple Urologic Institute, which launched in April. 

Aquablation is covered by Medicare and many private insurances, Dr. Sterious adds.