Can Water Save An Enlarged Prostate?

Older men are often plagued with an enlarged prostate, which increases their urge to urinate. The condition ranges from slightly bothersome to seriously affecting their quality of life—especially at night.

If lifestyle changes, natural therapies and medications fail to curb the symptoms then surgery may become necessary. As the “gold standard” procedure can have distressing side effects, minimally invasive alternatives have been developed, one of which looks very promising. It’s called aquablation.

If you’re affected by an enlarged prostate, then you’re in good company. About half of all men in their fifties have benign prostatic hyperplasia (BPH). This jumps to 70 percent for men in their sixties and 80 percent for the over eighties. Its precise cause isn’t known but it’s linked to hormonal changes that come with aging.

Symptoms of BPH

The prostate is a walnut-sized gland that produces seminal fluid and lies just below the bladder and surrounds the urethra (the tube through which urine flows), when it expands it presses on these areas to cause a range of symptoms that include:

• A delay in starting urination
• Reduced urine flow and dribbling
• Inability to completely empty the bladder
• Frequent urination
• A sudden, urgent need to urinate
• Frequent nighttime urination

Current Gold Standard Treatment

When other treatments don’t work, doctors often recommend surgery. Transurethral Resection of the Prostate (TURP) is one of the most common procedures, but it can cause a host of terrible side effects from infertility to incontinence. As a result, doctors have been looking for a new solution. And they think they’ve found it… transurethral water-jet ablation (aquablation).

Aquablation is a surgery that first involves scanning the patient’s precise anatomy with an ultrasound probe fed into the rectum and next to the prostate. The information gathered is then stored on a computer.

For the surgery itself, a separate probe is guided through the urethra to the prostate. Once there, under robotic instruction, a high-speed jet of water is targeted at specific areas of the gland. Tissue that’s dislodged is suctioned out and removed via another part of the probe.

The procedure takes between 45 minutes and an hour, with the patient under spinal or general anesthetic. Only one night is needed in hospital.

Aquablation is reported to have fewer complications than TURP, with under one percent left with continence issues and no risk of erectile dysfunction. A recent review of 54 studies concluded that the procedure “is efficient and safe…with sustained improvements in functional outcomes well maintained up to 5 years…good preservation of sexual function…and good compliance for all prostate sizes and patient ages.”

In a large double-blind, multicenter trial, patients with prostates of medium size were randomized to either aquablation or TURP. The conclusion was that “Aquablation yields superior long-term symptom relief and lower complication rates than standard transurethral resection, with notably lower rates of ejaculatory dysfunction.”

One member of the international team involved with the study was Neil Barber, a urologist from the UK. He’s very enthusiastic about the procedure which he’s carried out on patients since 2015.

“For the past 18 months, aquablation therapy has been offered to all my patients. It provides a better solution than TURP and can be performed as a day-case procedure, meaning more patients overall can be operated on.

“Most patients should be able to leave hospital within 24 hours, with some returning home the same day. We have a long history of happy and satisfied patients whose lives have been transformed by aquablation treatment.”

Superior to TURP

The National Institute for Health and Care Excellence (NICE), a UK body that advises the National Health Service (NHS) on evidence-based best practice, now recommends transurethral water-jet ablation (aquablation) as the first-line surgical treatment for BPH. So does the American Urological Association (AUA). The AUA guidelines recommend aquablation to patients based on the size of their prostate with the current range of prostate volume between 30 to 80mL.

There’s also natural help.

Help from Lifestyle Changes and Natural Therapies

For men who want to avoid drugs and put off surgery, the following lifestyle changes can often provide symptom relief.

• Avoid caffeine, alcohol, processed foods. Avoid foods and drinks containing caffeine, alcohol, and artificial sweeteners as these can increase urine production and irritate the bladder.
• Stay hydrated. Drink enough fluids during the day but drink little in the evening and nothing two hours before bedtime.
• Avoid constipation. Constipation can put pressure on the bladder - with fibrous fruits, vegetables, and whole grains.
• Avoid decongestants and antihistamines. This class of drugs may increase urine retention. Also check with your doctor if existing medications for any condition could worsen urinary symptoms.
• Double void. After peeing, wait for a minute and then try to urinate again. This technique helps to fully empty the bladder.

Some people also find relief with natural remedies. The remedies with the best and most thorough science behind them include saw palmetto, stinging nettle, pumpkin seed oil, Pygeum, beta-sitosterol, and rye grass pollen. There are numerous formulas containing one or more of these ingredients available in stores and online. We encourage you to try these natural approaches first, before considering surgery.