Mr Neil Barber
Urological Consultant, Frimley Park
Mr Rick Popert
Urological Consultant, Guy’s and St Thomas’
A revolutionary, heat-free treatment to tackle urinary problems in men, while reducing major side effects, has taken a step towards wider implementation across the NHS.
A robotic, heat-free technique treats a non-cancerous problem known as Benign Prostatic Hyperplasia (BPH), where men have difficulty passing urine due to an enlarged prostate.
Consultant urologist Neil Barber explained that the prostate enlarges in men from their late-40s and can lead to BPH. “That may start to affect the dynamics of urine flow out of the bladder and cause symptoms,” he says.
Treatment options for benign prostatic hyperplasia
The standard treatment for BPH has been Transurethral Resection of the Prostate (TURP), which is effective in relieving urinary symptoms but can damage nerves and parts of the prostate gland essential for sexual function.
Another option is a more radical laser technique known as HoLEP (Holmium Laser Enucleation of Prostate). While men can manage the condition by watching fluid intake, they may need medication or even surgery as their condition deteriorates.
Untreated BPH can lead to infections, bladder stones, incontinence or urinary retention resulting in a catheter being inserted into the bladder while waiting for treatment.
New therapy with NICE validation
Now, Aquablation Therapy, a new minimally invasive heat-free robotic therapy is being offered to patients. Recent recognition by the National Institute for Health and Care Excellence (NICE) as a technology that is effective, safe and has advantages for patients and healthcare systems effectively paves the way for wider use in the NHS.
Barber, a consultant at Frimley Health NHS Foundation Trust and a specialist in BPH surgery says the procedure sees a patient’s anatomy mapped on-screen using live ultrasound before a precise robotically controlled water jet clears a channel in the enlarged prostate, allowing urine to flow unimpeded, while preserving critical anatomy.
“A big positive for patients is that it achieves a successful procedure at a lower risk of affecting sexual function,” he says. “We now also have high-quality, long-term data which makes surgeons and urologists more comfortable talking to patients about this being a realistic option.”
A big positive for patients is that it achieves a successful procedure at a lower risk of affecting sexual function.Phil Dyer
Life after benign prostatic hyperplasia
Former chef Phil Dyer had retired to enjoy life and his passion for golf, but he suffered urinary retention as his bladder enlarged.
Tablets initially worked, but as his condition deteriorated, he had a catheter fitted before treatment with the Aquablation technique last December.
Phil, 69, from Whitstable in Kent, says: “Living with a catheter before the procedure, I was in a bad way, both physically and emotionally. Since being treated, I have my life back — not suffering pain, able to travel again, playing 2–3 rounds of golf a week, and it’s so nice to be back in the same bed with the woman I love.
The lives of many older men can be transformed by this procedure.
Predictable and efficient procedure
The procedure provides real-time imaging and automated tissue removal, combining the experience of the surgeon and precision of robotic execution to standardise outcomes for patients.
Rick Popert, Consultant Urological Surgeon at Guy’s and St Thomas’, says: “It offers lots of improvements for people who have enlarged prostates. It also provides us with the ability to treat larger, more complex anatomy than the standard of care. Using this robotic technique, not only we can treat more patients, but we can provide patients with a more consistent outcome in relation to symptom relief and preservation of ejaculatory, erectile and continence function. It is supported by five-year randomised control trial data.”
Procept BioRobotics Corporation’s day-case Aquablation is offered at Frimley, and the faster treatment and quicker recovery times can help increase patient throughput and free up beds to reduce NHS waiting times, says Barber.
It is also available at Berkshire Independent Hospital, Hampshire NHS Trust and Guy’s and St Thomas’ in London which has successfully used the robotic technique to treat as many as 10 patients in a day.