With water jet and steam against prostate disorders

Dr Wolters with a special endoscope used in the Rezum procedure. Copyright: &rsq

Dr Wolters with a special endoscope used in the Rezum procedure. Copyright: ’Karin Kaiser / MHH’.

MHH Urology completes the treatment spectrum for benign prostate enlargement with two gentle procedures

A frequent urge to urinate, going to the toilet at night, irregular urine stream - many men are familiar with these complaints. They can be an indication of benign prostate enlargement. In addition to medication, various surgical procedures are available for treatment. The Department of Urology and Urological Oncology at the Hannover Medical School (MHH) offers the entire range of therapies. These include two modern and gentle surgical procedures: Aquablation uses a high-pressure water jet to remove prostate tissue. The Rezum procedure uses hot steam.

Many men are affected

With advancing age, many men develop benign enlargement of the prostate. This is called benign prostatic hyperplasia, or BPH for short. The enlargement of the inner zone of the prostate leads to a narrowing of the urethra and the flow of urine is obstructed. The annoying symptoms around urination vary in severity. The standard surgical method for benign prostate enlargement is transurethral resection of the prostate (TUR-P). "The prostate is scraped out with the help of a wire loop and high-frequency current," explains senior physician Dr. Mathias Wolters, head of BPH therapy and functional urology at the Department of Urology and Urological Oncology.

Aquablation: New robot-assisted therapy method

But TUR-P is not the best method for all patients. "There are very good alternatives. The choice of method should be made according to the anatomical conditions and the personal wishes of the patient," says Dr Wolters. A year ago, the MHH Urology Department established the new minimally invasive aquablation procedure. In aquablation, the excess prostate tissue is removed with a high-pressure water jet. The operation takes place under spinal or general anaesthesia. Using a combination of ultrasound imaging and urethral and bladder endoscopy (cystoscopy), the tissue to be removed is first marked during the operation. The ablation itself is robotic and takes only three to six minutes. The urologist controls the process and can control the intensity or interrupt the procedure at any time. After the operation, the patient has to stay in the clinic for three to four days.

Low risk of sexual dysfunction

Aquablation is a heat-free procedure, which means that the surrounding nerves are spared. Clinical studies show that the method leads to a significant improvement in urinary flow and bladder emptying. The particular advantage is a lower rate of complications and sexual dysfunction. The risk of urinary incontinence, loss of ejaculation and erectile dysfunction is low. The aquablation procedure is also suitable for large prostate volumes.

Rezum: Gentle with steam

As a further treatment method for prostate problems, the Clinic for Urology and Urological Oncology is the only clinic in Hanover to offer the Rezum procedure. It is also called steam therapy and is a minimally invasive surgical procedure. During a urethral and bladder endoscopy, hot sterile water vapour is introduced into the prostate tissue at several points. "When the steam condenses in the tissue, heat energy is released that destroys the cell envelopes," explains Dr Wolters. The procedure takes only a few minutes. In the following days and weeks, the body breaks down the treated tissue, the narrowing of the urethra eases and urination becomes easier. After four to six weeks, the patient feels the effect set in. It can take up to three months for the therapy to have its maximum effect. "For the vast majority of patients, the discomfort eases significantly after a Rezum therapy and they regain a good degree of quality of life," Dr. Wolters states. This procedure also carries a very low risk of incontinence, erectile dysfunction and loss of ejaculation.

A light anaesthetic is usually sufficient

For the recum procedure followed by a two-day stay in hospital, a general anaesthetic can usually be dispensed with; a light mask anaesthetic is sufficient. The operation takes only 5 to 10 minutes. This gentle method is particularly suitable for two groups of patients: One is men who have actually opted for drug therapy but do not want to continue it, for example, because of side effects. The other group is men who are opposed to a surgical procedure or who have a high risk of anaesthesia or bleeding due to previous illnesses.

In addition to aquablation and the Rezum procedure, the Department of Urology and Urological Oncology also offers all other therapies for patients with prostate problems, for example TUR-P and laser enucleation. This makes the MHH one of the few clinics in Germany that offers the entire spectrum of modern BPH therapy. "Choosing the right treatment method is a very individual matter. A detailed consultation helps with the personal decision," says Dr Wolters.


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