Michael Smith, MD (Host): Welcome to the Better Health Podcast. I'm Dr. Mike, and joining me is Dr. Lauren Cooley, a Urologist and Urological Oncology Specialist from Tidelands Health. Welcome to the show today, Dr. Cooley. It's great to have you.

Lauren Cooley, MD, PhD: Thank you so much for having me.

Host: So today we're gonna be talking about aqua ablation therapy and how it can help men with BPH right, or benign prosthetic hyperplasia. But before we get into all that, let's back up and let's just talk about BPH first. Okay? What is exactly BPH and what are the common symptoms that men present with?

Lauren Cooley, MD, PhD: So BPH stands for benign prostatic hyperplasia, which is a long word that essentially means non-cancerous enlargement of the prostate. And as the prostate grows, men will start to have urinary symptoms. They may have dribbling after they urinate. They may feel they need to go more urgently or frequently than they used to go. They may wake up at night. They may feel that the force of the stream is more weak. And these are some of the warning signs that men will start to develop over time that suggest that their prostate is enlarging.

Host: Now, how long have you been practicing?

Lauren Cooley, MD, PhD: I've been practicing in this area for about two years, and prior to that I was in Chicago for seven.

Host: Okay, so you're experienced, you've seen a lot of patients. So, in the past, what were the common treatment options then for BPH?

Lauren Cooley, MD, PhD: There are many surgical options for BPH, and there's also medical management for BPH. So a lot of men will first get started on medications to help with these symptoms, and if medications are not working, they move on to surgery. Our surgeries in the old days used to be fairly invasive, requiring open surgery to remove the prostate or part of the prostate. However, now in more recent years, we have more minimally invasive options that remove prostate tissue without having to make a large incision. We actually will use, the native orifice and go through the penis and towards the bladder to treat the prostate.

Host: So that's kind of where we're getting into this aqua ablation therapy, right? We're hearing that more and more. I think a lot of people are interested just hearing aqua water, like what does that mean? So tell us a little bit about aqua ablation therapy and how it's actually working to shrink that prostate.

Lauren Cooley, MD, PhD: So aqua ablation is a minimally invasive surgery that's performed to remove part of the prostate tissue that's blocking the channel that men are trying to urinate through. I use an ultrasound that is visualizing the prostate and also what's called a cystoscope, which is essentially is a camera that is inserted in through the penis towards the bladder.

So I have two views of the prostate at all times during the procedure, and I'm able to map out in real time, what tissue needs to be removed. And what tissue is important for other functions, such as sexual function that needs to be preserved. And after I map out the tissue I wish to remove, actually a water-based treatment, think of it almost like a pressure washer; a water-based treatment is used to ablate that tissue. And then afterwards I put a scope in to remove any additional tissue that the treatment did not get, and then stop bleeding at the end of the procedure.

Host: So it's just water. Now is this water, is it heated up? Is there anything done to the water or is it just a high stream?

Lauren Cooley, MD, PhD: It is a high pressure water jet, so this is not heat based water in any way, and that's actually one of the reasons that aqua ablation has better sexual preservation than some of our other minimally invasive options is that there's less heat utilized during this procedure. And the fact that there's less heat; we think that reduces scar tissue that develops and it helps to improve and preserve sexual function after surgery.

Host: How long has it been around?

Lauren Cooley, MD, PhD: Aqua ablation has been around for over 10 years. However, it's become more mainstream in the last five or so years as their technology has advanced over time and more of us have started to incorporate it into our practice and patients are having very good results from it.

Host: In terms of efficacy, in terms of safety, recovery, how does aqua ablation therapy compare to some of the more traditional ways of doing this?

Lauren Cooley, MD, PhD: So one of our most traditional surgeries we do for prostate enlargement is called a TURP, or T-U-R-P. And this has been around for many years and this is a heat based approach that removes prostate tissue with heat during the procedure. And it is a very effective option. However, one of the things that aqua ablation is bringing to the table that TURP did not, one is this utilization of less heat and also the sexual preservation that it brings with the procedure. It also has very good efficacy at increasing your urinary force of your stream, emptying your bladder and the symptoms such as getting up at night, the frequency and urgency. And so multiple clinical trials have shown that men have a significant improvement in those urinary symptoms, they are able to get off of their medications that they were previously taking for this problem, and it will last you about five to 10 years without having the need to use medications.

Host: So aqua ablation is really helping to preserve the healthier tissue around the area that you're just trying to remove. Is that right?

Lauren Cooley, MD, PhD: Yep. So there's different zones of the prostate and the inner zone of the prostate, it is also called the transition zone, is the part that's blocking men's ability to urinate, but it's in a little bit of a high real estate location because the sexual function of the prostate helping to preserve ejaculation is nearby.

And so it's important that aqua ablation preserves that ejaculatory tissue while removing the obstructing tissue that's affecting urination.

Host: How long does this procedure take and do men go home the same day, or do they generally have to wait overnight? How does that work?

Lauren Cooley, MD, PhD: The exact time of the surgery will depend on the size of the prostate, but it typically takes me about 30 to 60 minutes to do the procedure, start to finish. So it is done with anesthesia, so you will be comfortable during the procedure. When the patients wake up, They do have a catheter in place. And that's because it can be difficult to urinate after prostate surgery, and that catheter typically stays in for about one to three days after surgery.

Right now, I do keep the patients overnight. However, we're moving toward a same day discharge pathway, which means that in the future, most men will probably be going home the same day after surgery as long as they feel comfortable with their catheter. And, as long as they're not having any issues after surgery.

Host: So who's the ideal candidate for this? Is there a specific area that aqua ablation is better at or can it be any size, shape, prostate issue?

Lauren Cooley, MD, PhD: So it's a great question because there is different sizes and shapes to the prostate. So this is meant to treat patients from small all the way up to large prostates, typically less than 150 grams, which is very specific. But in general, during our workup process, I'm gauging whether or not your anatomy would be sufficient and aqua ablation would be a good option for you. But most men, about 80% of men will probably fall into the category where aqua ablation would be an effective option for them. The one group of patients that, you have to be able to hold your blood thinning medication.

So for instance, if you take a blood thinner because you had a heart attack or a stroke, it's something that would need to be held prior to surgery. And we would work with your cardiologist or your primary care physician to help you with holding that medication.

Host: So what does the recovery look like? Let's say, the procedure's been done, they stayed overnight, they go home, and you mentioned they still have the catheter, right for a couple of days. Once that's removed what does recovery look like a week later, two weeks later for that patient?

Lauren Cooley, MD, PhD: So I tell patients for two weeks, I'd like you to take it easy. One of the things after prostate surgery is that we want to avoid any blood in the urine. So for two weeks after surgery, we say no heavy lifting. Try to take it easy for two weeks, but after two weeks you're getting back to your normal routine. Common symptoms after any prostate surgery is to have some irritative urinary symptoms, so a little burning when you urinate. A little bit of blood in the urine, a little bit of frequency for a week or two, and then those symptoms will get much better after the first week or so after surgery.

Host: Now for specialists like you when new innovations are coming out, you got aqua ablation here, what kind of training do you have to go through to master that, to be able to do it in your practice on a daily basis?

Lauren Cooley, MD, PhD: So whenever new technologies come out, they're typically based on older technologies that we have very good efficacy with and very good training with. And then we're essentially going to training courses.

We're going to watch live surgeries by other surgeons who are involved in the production of these new technologies. And, we're essentially building on our skills, and that's important as a surgeon, is you can't just rely on the technologies of 10, 20, 30 years ago. Constantly things are coming out and you need to stay current and up to date, and that's something that I'm very passionate about, making sure that I can offer up to date standard of care to my patients.

Host: So men who do have this procedure, you mentioned, traditional surgery, they often have to go home with some medications and stuff. Right. With aqua ablation, you were saying that's not the case so often?

Lauren Cooley, MD, PhD: With aqua ablation and any prostate surgery, our goal is really to get you off of medication, but not all surgeries can do that. Aqua ablation is one that after surgery, I typically keep you on your prostate medications for a couple weeks during the healing process, and then we stop those medications.

And that's something a lot of these medications men have been taking for years, sometimes 10, 20 plus years. And these things have side effects and often things that we might not even know that they're causing. So our goal is really to get you off of these medications and get you back living your life, not revolving around having to go to the restroom so often.

Host: Yeah. So speaking of those symptoms, whether it's nighttime urination, urgency, you know what, whatever it may be for that man or that patient, when do they see actual improvements in those symptoms?

Lauren Cooley, MD, PhD: So the first thing that improves is the obstructive urinary symptoms. So if you have a weak stream, dribbling; those sorts of things are almost immediately improved right after surgery. Patients will say, wow, the flow is just, it's miraculous. And then those irritative symptoms such as urgency and frequency, those start to improve over the next coming weeks.

And that's because a lot of those symptoms revolve around bladder stress that has been going on for many years because the bladder has been trying to push against this big prostate for many years to evacuate the urine and the bladder, it takes a little bit of time to heal, and so again, the first thing they notice is the flow and those obstructive symptoms are so much better, and then those irritative symptoms start to also improve over time.

Host: So in summary what would you like people to know about BPH and aqua ablation therapy?

Lauren Cooley, MD, PhD: I would like them to know that BPH is a very treatable condition. You do not have to stay on medications chronically, and if those medications are not working for you anymore, there are very safe and effective surgical options that we offer here at Tidelands Urology to help you. Aqua ablation is one of those technologies that is very safe and very efficacious and with your interest in mind. It has very good sexual preservation and it also has very good efficacy for helping to treat your urinary symptoms.

Host: Dr. Cooley, that was a fantastic interview, great information. Thank you for coming on today.

Lauren Cooley, MD, PhD: Thank you so much.

Host: For more information, you can visit tidelandshealth.org or call 1-866-TIDELANDS. That's 1-866-TIDELANDS. If you enjoyed this podcast, please share it on your social channels and explore our entire podcast library for more topics of interest to you. This is the Better Health Podcast. I'm Dr. Mike. Thanks for listening.