Rezūm, UroLift and Aquablation: what to know before deciding

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0:01 Doctor, I've seen a new prostate technique online that doesn't require hospitalisation, preserves ejaculation, and is minimally invasive. Is it true? Today I'm going to talk to you about the three techniques that are most talked about lately: Aquablation, Rezum, and Urolift.

0:18 I'm going to give you some data without any commercial interests. I am Doctor Fernando Gómez Sancha. I've been in urology for more than thirty-two years and have operated on more than ten thousand patients with prostate lasers, and I closely follow all the scientific evidence on new techniques.

0:36 I'm going to tell you what the studies say, not what the marketing says. Let's start with Urolift. Urolift is a system that places staples that compress the prostatic lobes. It's like ...

0:49 trying to open curtains to let the urine through. It's done without general anaesthesia. It can be done in a small outpatient operating room in about fifteen or twenty minutes with sedation and local anaesthesia, depending on the centre.

1:06 The main advantage advertised is that it preserves ejaculation. The problem: the long-term data are not good. The retreatment rate at five years is around fourteen percent. That is to say, one in seven patients needs another intervention.

1:24 It only works on small and medium-sized prostates, especially when there is no median lobe, a growth of the median lobe. And the improvement in urinary flow is significantly less than if a conventional transurethral resection or a laser enucleation is performed.

1:41 To be fair, it can be an option for young patients with very small prostates who prioritise preserving ejaculation. But you have to know that in most cases it is not a definitive solution.

1:55 Let's move on to Rezum. Rezum uses water vapour injected directly into the tissue of the prostatic adenoma. That vapour will destroy the cells and little by little the tissue is reabsorbed in the following weeks.

2:11 It is usually done with sedation and is also presented as a technique that preserves ejaculation. The five-year data show a retreatment rate of four to eleven percent, depending on the study.

2:25 Being a cavitative technique, a technique that creates a hole inside the prostate, it has better results than Urolift, but worse than HoLEP, which is laser enucleation. The improvement in symptoms and urinary flow is moderate, not as good as after an enucleation.

2:44 And the worst thing is that there is a very uncomfortable postoperative period. There are patients who need to wear a catheter for a few days or weeks while the tissue is reabsorbed.

2:55 And now they're going to spend a month with very annoying symptoms. It's true, as I've said, that being a cavitational technique, it can produce permanent improvement and, in many cases, preserve ejaculation.

3:09 But as residual adenomatous tissue remains, the risk of long-term retreatment will be higher than with enucleation, although there are no studies yet looking at long-term data. And now we're going to talk about Aquablation.

3:24 Aquablation uses a high-pressure water jet guided by a robot and transrectal ultrasound to destroy the prostatic tissue. It's presented as a precision robotic technique that is independent of the surgeon.

3:40 The data is mixed regarding its efficacy. The urinary improvement results are good, comparable to transurethral resection, and that's how I conceptualise it. It's a cavitational technique that removes tissue, similar to when a transurethral resection is performed.

3:56 But regarding safety, there are studies showing significantly higher rates of serious complications than with enucleation. A study published in twenty twenty-four comparing Aquablation with HoLEP showed thirty-seven point five percent Clavien-Dindo grade three b or higher complications with Aquablation versus four point two percent with HoLEP.

4:18 There are other studies that, uh, report the occurrence of a serious complication, which is rectal perforation. A disaster for a patient being treated for a benign condition like benign prostatic hyperplasia.

4:32 It's a significant difference. Furthermore, it causes more postoperative bleeding. Some patients require transfusions. I'll be direct and clear: each of these techniques has a legitimate niche, and I don't rule them out completely.

4:46 But when a patient asks me which technique has the best long-term results, lowest retreatment rate, and highest proven safety, the evidence-based answer is laser enucleation. Why do these techniques become so popular if the data isn't that good?

5:04 Well, for two reasons. The first is marketing. The companies that manufacture these devices invest millions in promotion, sponsored congresses, and training opinion leaders. And the second is the learning curve.

5:17 These techniques are easier to learn than laser enucleation, making them attractive to urologists or, or urology centres that don't want to or can't invest the time required to master laser enucleation.

5:31 My advice: inform yourself well before deciding. Ask your urologist about the five and ten-year retreatment rates. Ask about the complications. Don't just settle for the promise of no hospital stay or preserved ejaculation, because these advantages aren't so good if you have to have surgery again in three or four years.

5:52 In the description, you have links to the studies I've cited. It's data, not opinions. Subscribe and I'll see you in the next video.