Melanie Cole, MS (Host): Acquablation therapy is a new type of surgical treatment for benign prostatic hyperplasia, or BPH. Henry Mayo Newhall Hospital is among the first in the Santa Clarita Valley to offer this advanced, minimally invasive treatment. Acquablation therapy at Henry Mayo Newhall Hospital helps men suffering from BPH to get their lives back and feel like themselves again.

 Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Dr. Edward Forsyth. He's an Assistant Professor of Clinical Urology on the Medical Staff of Henry Mayo Newhall Hospital and Keck Medicine of USC. Dr. Forsyth, I'm so glad to have you with us today.

Tell us a little bit, before we get into this procedure of aquablation, which is so exciting. Tell us a little bit about what happens to the prostate as men age and what is BPH? How common is this?

Edward Forsyth, MD: Hi, Melanie. And it's good to be back. BPH is a very common illness that affects many, many men. It stands for benign prostatic hyperplasia, but we think of it more as just an enlarged prostate. And the prostate is a gland that surrounds the male urethra and helps contribute to the fluid involved in semen.

As men get older, that gland can enlarge and constrict the flow of urine out of the urethra. If it doesn't affect you, it probably affects one of your friends because it's just a very, very common, illness.

Host: Tell us a little bit about some of the symptoms that a man would notice, or as I like to say, his partner would notice because these are things that really do affect the quality of life, getting up at night, all these things. Tell us some of the symptoms.

Edward Forsyth, MD: So the main symptoms have a wide variety, but they basically fall into failure to empty or failure to store. And if you're not able to store urine, you're not able to, say, sit through a movie or sit through a full meal. You have to get up to go to the bathroom very frequently. We expect someone to be able to hold their urine at least three hours, you know, around there.

But if it's every hour, every half hour, your partner will certainly notice you're not around as much because you're always in the bathroom. The other issue can be urgency where, when you need to go, you need to go right now and you better get out of my way or, or we're going to have an accident. So that's frequency and urgency. And you might also see nocturia, which is getting up at night. Getting up once or twice, we can maybe expect as people get older, but any more than that and you're really disrupting sleep and affecting the quality of life. The other thing you can notice is failure to empty urine, which is straining, pushing hard with your abdominal muscles to try to empty urine, a weak stream, or it could be double voiding where you think you're finished and then you're washing your hands and then before you know it, you have to go again.

This is all a symptom of that prostate bothering the bladder and impairing its ability to either hold urine for any period of time or to get rid of it.

Host: Well, then tell us about this exciting technology of Aquablation. I mean, really BPH and the treatment for prostate issues has evolved so much over the decades. Tell us a little bit about that.

Edward Forsyth, MD: As the prostate gets very large and blocks the flow of urine through this urethra, we have a variety of procedures to open up that tissue to help the flow of urine. And this started, the onset of urology with an open incision and performing surgery to remove the inside part of that prostate gland. And over time, we've now developed these endoscopic techniques with no incision to remove that tissue from the inside. And how aquablation works is a ultrasound is used to take a very high resolution image of the prostate. This is done under anesthesia and a robot controlled water jet is used after we draw a map of the gland to destroy the tissue that we know to be causing these symptoms.

And then, the robot is able to control this stream of water, which can destroy the tissue using mechanical energy. And then doing so will open up this channel of urine, and really improve the stream. And in some of the studies, the quality of life scores, as far as how much bother someone was having, were cut in half. So we're talking about really significant improvement.

Host: That's so cool. Really an exciting time in your field, Dr. Forsyth. Tell us a little bit about patient selection for men listening and for the people that love them that are noticing these things that they have to get up, that they can't finish a game of golf or they can't sit through a movie. Tell us a little bit about how you determine whether a patient is acceptable for this procedure or is it pretty much open for everyone?

Edward Forsyth, MD: Well, the main thing that I tell to anyone, my friends, my family, you know, is don't suffer and don't just think that as you get old, you're, as you get older, of course, as you get older, you shouldn't just say this is normal for me to be miserable from my symptoms. So, come in and let's talk, we'll get you checked out. There are a variety of options. There are medications that can help, so we often start with those. Medications can help the flow of urine, but some people don't want to take a pill every day or some people have side effects or otherwise don't tolerate taking the medicines. And then we just do a basic exam to get a rough idea of the size of the prostate.

We'll probably talk about making sure you're at low risk for prostate cancer. And then what's amazing about aquablation, is that it's able to be very effective on almost any size prostate gland. So as the gland gets very, very big, some of the other minimally invasive modalities are just not effective or not safe.

So that again becomes requiring of a more, more invasive or a larger procedure. What's amazing about aquablation is after you take that picture with the ultrasound and you make the map of the of the gland, the robotic controlled jet can take care of very large prostates in a very efficient and safe way, so that most people are eligible for this, barring, significant other health concerns that we would talk about.

Host: I think the biggest question that men always have, because they are so concerned with side effects, erectile dysfunction, incontinence, any of those things, does aquablation have any of those kinds of side effects and how long do the results last? It's like you're cleaning it up, opening up this area. Does it go back the way that it was and have to be repeated?

Edward Forsyth, MD: This is an excellent question. I perform a TURP as well, which is the old fashioned, more gold standard procedure, and for that I give a 10 year warranty. That has very low risk of incontinence and it has significant risk, it's very common for a man to lose the ejaculate, meaning their ability to orgasm and function sexually is still there, but nothing comes out.

And so that is very bothersome to some people and it's, it's not bothersome to others. But with aquablation, that ability to preserve the full function is present in up to 90% of men. So when we, again, create that map, we're able to preserve the areas that we know to be important in preserving that function and so that sexual function is able to be preserved.

We have very excellent five year data to show that the aquablation is effective for five years. The retreatment rate is below 5%, so that's people who need something else done. And it's similar to the, the TURP in that tissue is removed. And it's just removed kind of more efficiently and with visual guidance.

So I fully expect the 10 year data to mimic that 10 year warranty that I give on the TURP. But it's again, a newer therapy, so we just haven't had people have it for that long, but so far the results are very promising.

Host: And Dr. Forsyth, what is the procedure like for the man? Is it in office? Is it an overnight stay, outpatient? What is that like? Does it hurt for them?

Edward Forsyth, MD: So, the procedure is performed under general anesthesia because we need the prostate to be very still while we're making the map. So, the patient will not feel any pain during the procedure, certainly. We do require a catheter and often an overnight stay for monitoring, but it's not required for everybody.

And after we assess the patient in the recovery room, we're able to determine whether they're able to go home that same day and sleep in their own bed.

Host: This is great information. So informative. Dr. Forsyth, as we wrap up, how does this treatment compliment the total approach to BPH and other prostate issues at Henry Mayo Newhall Hospital and Keck Medicine of USC? How does this treat the whole man and fit into that picture of a comprehensive approach?

Edward Forsyth, MD: Acquablation is a really good option for a lot of men who are bothered by their urination symptoms and are interested in a definitive procedure to help the flow of urine and make those symptoms better. Part of our discussion will involve medication management and some people need more invasive procedures done.

But the vast majority of men are good candidates for this very versatile and effective procedure and we're really excited to be able to offer it here in the Santa Clarita Valley.

Host: Thank you so much, Dr. Forsyth, for joining us today. And to learn more, please visit henrymayo.com/BPH. You can also visit the free health information library at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and be sure to share this show with your friends and family because we are learning from the experts at Henry Mayo Newhall Hospital together. I'm proud to host this show. Thanks so much for listening.