Overview of Water Vapor Thermal Ablation of the Prostate

Water vapor thermal ablation of the prostate (WVAP) is a simple surgical procedure used to treat a condition known as benign prostatic hyperplasia (BPH), which is an enlargement of the prostate that commonly occurs as men get older. The treatment was approved by the United States Food and Drug Administration in 2015.

BPH becomes more common as men age, affecting 50% to 75% of men over the age of 50 and 80% of men over 70. This issue can cause bothersome symptoms involving the urinary system. These symptoms can include frequent need to urinate, struggle to start urinating or maintaining the flow, complete emptying of the bladder can also be an issue as well as having to wake up to urinate during the night.

BPH can also cause other health issues such as urinary retention, recurrent urinary tract infections, blood in urine, and kidney problems.

Standard treatments for BPH include taking regular oral medications and undergoing surgical procedures. WVAP is used to relieve symptoms by destroying enlarged prostate tissue through the application of radio frequency-generated steam or water vapor. The vapor, which is lighter and less dense than prostate tissue, can move easily between cells. However, it cannot pass through natural barriers within the prostate, making it effective in targeting the specific areas where BPH most commonly occurs. This helps minimize potential damage to surrounding structures including the bladder neck, urinary sphincter, prostate skin, semen-producing glands, blood vessels in the prostate, and the rectum.

WVAP can be performed either in the doctor’s office or an operating room and usually takes about 10 minutes. The full benefits may not be seen until up to a year later as it can take that long for the body to naturally get rid of the destroyed prostate tissue. During this period, the urinary symptoms gradually improve.

Studies involving more than 2,000 patients have shown that WVAP is effective in significantly reducing bothersome urinary symptoms and improving overall quality of life. Importantly, WVAP has proven effective in reducing symptoms in patients with larger prostates or those with prostates that have grown into the part of the urinary canal passing through the prostate.

Anatomy and Physiology of Water Vapor Thermal Ablation of the Prostate

The prostate gland is a cone-shaped organ located below the bladder, behind the pubic bone, and in front of the rectum. Doctors can check the health of your prostate by conducting a digital rectal examination as it is easily accessible. The prostate size can differ from person to person and it usually gets bigger as men age. The average prostate weighs about 33 grams.

The prostate gland is divided into five parts or ‘lobes’: the front, middle, back, and the left and right sides. These lobes surround a tube called the prostatic urethra. When a condition called Benign Prostatic Hyperplasia (BPH) develops, the middle and side lobes get bigger. This can block the urinary tract and make it hard for you to pass urine which can lead to discomfort and other symptoms.

The prostate gland is divided into different areas or ‘zones’ based on their function. These include the transitional, central, and peripheral zones. There is also a fourth region called the anterior fibromuscular stroma, even though it doesn’t have any glands.

The transitional zone surrounds the urethra, which is a tube that carries urine from the bladder. Though it only makes up 5% of the prostate, it is where BPH mainly happens. The central zone is at the base of the prostate, between the other two zones. It surrounds the tubes that carry sperm. The peripheral zone makes up the rest of the prostate. It surrounds most of the central zone, extending downwards around the urethra. Most of the prostate tissue is found here and it is the main spot for prostate inflammation and cancer. The anterior fibromuscular stroma is a band of tissue in front of the transitional zone, between the bladder and the external sphincter, a muscle located at the bottom of the prostate.

The prostate gland gets its primary blood supply from the prostatic arteries, which come from the inferior vesical arteries. These arteries branch off from the internal iliac artery and divide further into the capsular and urethral groups of arteries. The prostate arteries are short and mainly found at the neck of the bladder. The prostatic venous plexus is a network of veins that surrounds the prostate and drains into the internal iliac vein, providing the primary drainage for the prostate gland.

The prostate gland also has a neurovascular bundle responsible for erection, ejaculation, and urinary control. This bundle can sometimes be damaged during some procedures, leading to erectile dysfunction. Nonetheless, it’s located outside the prostate and isn’t affected during certain operations.

Surgeons also take note of particular features or ‘landmarks’ during prostate operations. These include the ureteric orifices, bladder neck, prostatic lobes, verumontanum, and urinary sphincter.

The prostate gland has one sole function: to produce fluids that nourish the sperm and increase fertility. The fluid is a mixture of citric acid, fibrolysin, acid phosphatase, and proteolytic enzymes, all of which improve the consistency of semen. These fluids also contain most of the sperm-protecting antibody, immunoglobulin A. Prostate fluids make up about 30% of the total semen volume.

The exact cause of BPH isn’t entirely understood, but the male sex hormone testosterone is thought to play a role. Dihydrotestosterone, which is created from testosterone by enzymes, is believed to increase in the prostate with age, even as testosterone levels in the blood fall. Metabolic changes or inflammation may also trigger BPH.

BPH symptoms usually involve the enlargement of the side lobes from the transitional zone.

Why do People Need Water Vapor Thermal Ablation of the Prostate

If you’re experiencing symptoms like weak urine flow, incomplete bladder emptying, or having to urinate frequently at night, you might be suffering from Benign Prostatic Hyperplasia (BPH), a condition where the prostate gland becomes enlarged but not cancerous. As a result, these symptoms can significantly affect your quality of life. This condition often warrants treatment, especially if you have moderate-to-severe symptoms or changes in prostate size, leftover urine volume after urination, and deterioration in urine flow.

There are various ways to manage BPH, and your doctor will help you to understand each one – how it works, its benefits, and potential downsides. Usually, the first method your doctor would try is medication – specifically, a group of drugs known as α-blockers, sometimes with the addition of other drugs like 5α-reductase inhibitors. However, if this doesn’t work, gives you side effects, or you want a more lasting solution, there are other treatments available.

Options beyond medication include surgical treatments that are minimally invasive, traditional endoscopic procedures, and others like prostatic artery embolization. A complex procedure, prostatic artery embolization is not commonly available, yields modest results, and is only an option for patients for whom all other treatments are undesirable. The treatment’s ineffectiveness is evidenced by its 21% retreatment rate and the technical difficulties that accompany it.

Minimally invasive surgical treatments include methods like water vapor thermal ablation (WVAP), prostatic urethral lift, and Optilume® BPH. These treatments aim to preserve sexual function, offer symptom relief, pose minimal operative risks, and can be performed under various types of anesthesia. The choice of treatment is influenced by factors like the size of the prostate, severity of symptoms, patient preference and health conditions, and the pros and cons of each treatment. Even though all these treatments are effective, their suitability may vary depending on the patient and the specifics of their condition.

Specifically, WVAP is recognized as an effective treatment for BPH by the American Urological Association. This treatment is optimal for men with medium-sized enlarged prostates who want to preserve their sexual function and are prepared for potential minor reduced effectiveness and durability of this less-invasive treatment. It only requires about 10 minutes of operation time and is ideal for patients in whom more invasive surgical options or prolonged anesthesia is too risky.

In contrast to other minimally invasive treatments, WVAP is proven effective for all prostate shapes and sizes, even for enlarged or obstructing prostate tissues, making it a highly versatile treatment option.

When a Person Should Avoid Water Vapor Thermal Ablation of the Prostate

There are some reasons why Water Vapor Ablation of the Prostate (WVAP), a treatment for an enlarged prostate (also known as symptomatic BPH), might not be suitable for everyone. Doctors need to carefully review your medical history to make sure this treatment is safe and effective for you.

For instance, people with urinary sphincter or penile prosthetic implants, or who have had prostate radiotherapy in the past, should not have WVAP. The prosthetic implants might get damaged during WVAP. Also, the scarring from radiotherapy might stop the water vapor from spreading properly within the prostate.

A detailed check-up before the operation can help identify and manage many of the factors that could make WVAP unsuitable for some people. Before considering WVAP or any other surgical treatment for an enlarged prostate, it is important to have a urine flow test to check bladder performance and ensure there is no urinary retention (difficulty in completely emptying the bladder).

WVAP doesn’t provide any tissue samples for lab tests. So, if there is a suspicion of prostate cancer, more traditional diagnostic methods should be used to confirm or rule out the possibility before deciding to proceed with WVAP. It’s also necessary to test for urinary tract infections. If an infection is present, it should be treated and eliminated before undergoing WVAP.

Existing data on how effective WVAP is for people with a very large prostate (more than 120 cm3) is limited. For this reason, if your prostate is this size or larger, your doctor will likely be cautious about recommending WVAP. Having a device called a prostatic urethral lift can also lead to complications after WVAP, such as infections and kidney stones. Special examinations should be carried out if you have such a device.

Finally, having a scars in the bladder neck or a condition known as Marion’s disease might make WVAP less effective. This is because WVAP works best in the prostate’s transition zone and is not as effective at the bladder neck. In some cases, a small cut might be made in the bladder neck, especially in patients with smaller prostates and high or tight bladder necks. This helps to reduce the need for additional treatment down the line.

Equipment used for Water Vapor Thermal Ablation of the Prostate

To carry out a Water Vapor Ablation Procedure (WVAP), which is a non-invasive treatment for an enlarged prostate, several tools are needful:

  • A water vapor generator system and a device to deliver it. This is the main equipment used to treat the enlarged prostate by delivering small amounts of steam to specific parts of the prostate.
  • A bed that supports the lithotomy position. This special kind of bed allows the patient to lie in a specific posture where legs are flexed and spread, useful for a medical procedure in the pelvic area.
  • Sterile skin preparation solution. It’s a certain liquid used to cleanse and reduce germs on the skin at the site where the procedure will be performed.
  • Sterile patient drapes, which are the big sheets used to cover parts of the patient’s body not involved in the surgery to maintain a sterile environment.
  • Warmed normal saline and tubing with an IV pole. Normal saline is a sterile mixture of salt and water; it’s warmed to body temperature and delivered through the tubing hanging on a stand (IV Pole).
  • Topical lidocaine gel. This is a gel that numbs the skin area where the procedure will be conducted to reduce pain or discomfort for the patient.
  • A cystoscope lens, which is a special thin tube with a light and a tiny camera on the end that’s inserted up the urethra to allow the doctor to see inside the bladder and the prostate.
  • A 2-way urinary catheter with drainage bag. This is a thin tube inserted into the bladder to allow urine to travel from the bladder to a drainage bag outside the body.
  • A transrectal ultrasound, which might be used to obtain an image of the prostate using sound waves. This process helps in giving local anesthesia to the prostate.
  • Local anesthetic. It’s a medication that causes lack of feeling in a small area to prevent pain during the procedure. This is optional and up to the doctor’s discretion.

Who is needed to perform Water Vapor Thermal Ablation of the Prostate?

When WVAP (a type of medical procedure) is done at a local clinic, only the main doctor or surgeon and an assistant are needed. This means, a simple team of two professionals handle the procedure.

However, if WVAP is done in a hospital operating room, the team becomes larger and typically includes:

* The surgeon, who leads the procedure.
* A surgical technician or operating room nurse who assists with the operation.
* A circulating or operating room nurse who helps in other non-surgical tasks.
* Anesthesia personnel, who ensures you don’t feel any pain during the process.

This team is put together to make sure the operation goes smoothly and safely.

Preparing for Water Vapor Thermal Ablation of the Prostate

When a patient is considering surgery for lower urinary tract symptoms due to Benign Prostatic Hyperplasia (BPH – a common condition where the prostate gland is enlarged and causes discomfort), a thorough medical history is needed. This includes documenting any symptoms related to urination such as frequent needs to urinate, feelings of not fully emptying the bladder, irregular flow of urine, needing effort to start urination, or waking up to urinate at night. Tools like the AUA or IPSS questionnaire can be used to help discuss these symptoms and monitor the patient’s progress after the surgery.

It’s also important to check if the patient ever suffered from painful urination, blood in urine, incontinence, or stones in the urinary tract. Any previous treatments for urinary disorders should be noted as well. The doctor will also ask about the patient’s general medical and surgical history, especially any issues related to anesthesia, the urinary system, or radiation therapy to the prostate. Sexual function will also be evaluated, as well as any risk factors for urological disease like smoking, exposure to certain chemicals at work, or a family history of BPH or prostate cancer.

A physical examination will be done which includes checking the genital area for any abnormalities and a rectal examination to estimate the prostate size and check for any signs of prostate cancer.

Pre-surgery tests will include a detailed analysis of urine, and a test called Prostate-Specific Antigen (PSA) to rule out prostate cancer. There will be other tests like uroflowmetry to understand the severity of the urinary issues and also identify the underlying cause. They also measure the flow of urine, how much urine is left in the bladder after urinating, and analyze the patient’s urination patterns. In certain cases where other pathologies are suspected, additional urodynamic tests might be deemed necessary.

An ultrasound to gauge the size and shape of the prostate and a flexible cystoscopy – a procedure to look inside the urinary bladder and the urethra – will also be performed to plan the surgery. The surgeon will also use this procedure to gauge the patient’s tolerance to pain, which will be helpful information for surgeries that might be done under local anesthesia.

Once all the necessary examinations and tests are complete, the doctor and patient will discuss the treatment plan. This will include ensuring the patient understands the procedure, the risks, benefits and recovery process. The patient will also be provided with alternative treatment options such as waiting and watching the progress of the symptoms, medication, minimally invasive surgeries, or other endoscopic procedures.

How is Water Vapor Thermal Ablation of the Prostate performed

The WVAP water vapor ablation system is used to treat an enlarged prostate by heating up water to make steam. This system consists of a machine that makes the steam and a medical instrument that doctors insert into the bladder through the urethra (the tube where urine comes out of the body). The device has a tiny camera lens on it that allows the doctor to see what they are doing. The steam is created by applying a particular frequency of electricity to the coil of the machine. This vapor is injected directly into the prostate, where it spreads quickly and evenly. Upon contact with the tissues of the prostate, the steam condenses, releases its heat, and causes immediate cell death. This results in a tiny, perfectly spherical lesion or wound.

Before starting the procedure, the doctor ensures the patient is properly positioned and that the area around the genitals is thoroughly cleaned to prevent infection. An antibiotic is also typically given before the surgery based on guidelines in the area or the patient’s urine test results. The type of anesthesia or numbing medicine used should be decided in a thorough discussion between the urologist, the patient and the anesthesiologist, and they should choose what works best for the individual. Options include general anesthesia, sedation, or a local numbing injection directly into the prostate.

For the procedure, the doctor first applies a numbing jelly into the urethra, then inserts the delivery device. Under the guidance of a tiny camera, the doctor injects the steam directly at the bulkiest part of the prostate tissue to be treated. The injection needle spreads the steam evenly within an area of a few millimeters in a spherical pattern to create a tiny lesion. This process takes about 9 seconds to complete, following which the needle is left in place for an additional couple of seconds. Additional injections are given at regular intervals to treat different areas of the prostate. The process is performed methodically on one side of the prostate before proceeding to the other side to maximize the effectiveness of the treatment.

At the end of the procedure, a small soft tube called a Foley catheter is inserted to help with urination as the prostate heals. This stays in place for a couple of weeks based on the doctor’s assessment and the number of injections given. Some patients might be able to try urinating on their own after the third or fourth day post-surgery. However, people who have a history of bladder issues, or who were unable to empty their bladder completely before the operation might fail this trial and need a catheter for up to four weeks.

Patients should be aware that they might experience symptoms like frequent urination or inability to hold their urine normally for a brief period after the surgery.

Possible Complications of Water Vapor Thermal Ablation of the Prostate

A method of treatment for prostate problems called WVAP takes about 10 minutes to perform and usually goes smoothly without any problems during the surgery. However, some complications might occur after the operation, mostly minor and can generally be managed well.

Following the surgery, the affected tissue inside the prostate is gradually cleared away by the body’s natural response to injury. This might lead to symptoms like a burning sensation during urination, feeling the need to urinate often, and blood in the urine. For patients who have a catheter (a tube for draining urine from the bladder), the chances of getting infections in the urinary tract might be higher. Additionally, there may be difficulty in passing urine, especially in those who already had this issue prior to surgery. It usually takes a minimum of three months for these symptoms to go away. However, if a patient has had other prostate surgeries before, these symptoms might still remain after the WVAP procedure.

The most significant long-term issue after a WVAP procedure is that the symptoms might return. About 4.4% of men who undergo WVAP might need another operation within 5 years, and 11% might need medication for their prostate issues. The repeat surgery is more likely for men with certain prostate or bladder conditions, like an obstructed bladder opening, an uneven prostate shape or unexpected formations such as cysts or cavities in the prostate. In some cases, these men could simply benefit from a surgical procedure that opens up their bladder neck, a part of urinary tract that connects the bladder with the urethra.

Other long-term complications are rare but might include urethral strictures (a narrowing of the urethra) or contractions at the neck of the bladder, which may affect the flow of urine.

What Else Should I Know About Water Vapor Thermal Ablation of the Prostate?

Benign prostatic hyperplasia (BPH) is a very common issue often seen as men age. BPH can cause uncomfortable symptoms related to urination and negatively impact a man’s overall quality of life. WVAP is a commonly opted for minimally invasive surgical treatment used to alleviate these symptoms. This procedure involves using controlled radiofrequency (uses electrical current) to produce heat that destroys excess prostate tissue blocking the urinary canal, thereby relieving the obstruction. It is precise in targeting only the problematic areas of the prostate, significantly reducing the risk of injury to surrounding tissues and organs.

One of the perks of this procedure is that it takes about 10 minutes and can preserve sexual functions like ejaculation and erection which are often compromised with other treatments. It, therefore, can be done in many different medical settings, providing flexibility for patients and doctors alike.

When compared to other minimally invasive therapies for BPH, WVAP offers long-term relief from symptoms and works efficiently across varying sizes of the prostate. Uniquely, it’s proven to be effective even in patients with a specific type of prostate enlargement (“obstructing median prostatic lobes”).

Although patients with prostate cancer can undergo WVAP treatment, it’s imperative to note that it doesn’t treat the cancer itself. It is intended strictly to ease symptoms related to obstructed urinary flow in appropriate candidates. This process is particularly beneficial for men with moderately enlarged prostates who wish to sustain sexual function and steer clear of more invasive surgical treatments. It might also be an excellent option for those at higher risk from general anaesthesia or for whom drugs for BPH are ineffective or cause unpleasant side effects.

Following the WVAP procedure, patients typically experience marked improvement in symptoms related to urination. These improvements might include an increase in the rate of urinary flow, a reduction in the volume of urine left in the bladder after urination, a decrease in the registered magnitude of urinary obstruction, a reduction in the size of the prostate (especially in areas causing obstruction), and a significant reduction in the severity of symptoms according to a commonly used scoring system.

Frequently asked questions

1. How does Water Vapor Thermal Ablation of the Prostate work to treat my condition? 2. What are the potential risks and complications associated with this procedure? 3. How long will it take for me to see the full benefits of the treatment? 4. Are there any specific factors or conditions that may make me ineligible for Water Vapor Thermal Ablation of the Prostate? 5. Are there any alternative treatment options that I should consider?

There is no information in the given text about the specific effects of Water Vapor Thermal Ablation of the Prostate.

You may need Water Vapor Thermal Ablation of the Prostate if you have an enlarged prostate (symptomatic BPH) and meet certain criteria. This treatment can be effective in reducing symptoms and improving urinary flow. However, it is important to consult with your doctor to determine if this treatment is suitable for you based on factors such as your medical history, the presence of urinary sphincter or penile prosthetic implants, previous prostate radiotherapy, prostate size, presence of prostate cancer, urinary tract infections, and other conditions that may affect the effectiveness of the treatment.

Water Vapor Ablation of the Prostate (WVAP) may not be suitable for everyone due to factors such as having urinary sphincter or penile prosthetic implants, previous prostate radiotherapy, suspicion of prostate cancer, urinary tract infections, a very large prostate, having a prostatic urethral lift device, scars in the bladder neck, or Marion's disease. It is important to have a thorough medical history review and check-up before considering WVAP to ensure safety and effectiveness.

The recovery time for Water Vapor Thermal Ablation of the Prostate is not explicitly mentioned in the provided text.

To prepare for Water Vapor Thermal Ablation of the Prostate, the patient should undergo a thorough medical history evaluation, including documenting any symptoms related to urination. Pre-surgery tests such as urine analysis and Prostate-Specific Antigen (PSA) test will be conducted to rule out prostate cancer. The patient will also undergo physical examinations, including a rectal examination to estimate the prostate size and check for signs of prostate cancer.

The complications of Water Vapor Thermal Ablation of the Prostate include symptoms such as a burning sensation during urination, frequent urination, and blood in the urine. There is also an increased risk of urinary tract infections for patients with a catheter. Difficulty in passing urine may occur, especially in patients who had this issue prior to surgery. These symptoms usually take at least three months to resolve. Long-term complications may include the return of symptoms, with about 4.4% of men needing another operation within 5 years and 11% needing medication. Other rare long-term complications include urethral strictures and contractions at the neck of the bladder, which can affect urine flow.

Symptoms that require Water Vapor Thermal Ablation of the Prostate include weak urine flow, incomplete bladder emptying, and frequent urination at night.

Water Vapor Thermal Ablation of the Prostate (WVAP) is not typically performed during pregnancy. WVAP is a surgical procedure used to treat an enlarged prostate, which is a condition that occurs in men. Pregnancy does not involve the prostate gland, so WVAP is not relevant or necessary during pregnancy. It is important to consult with a healthcare professional for appropriate treatment options during pregnancy.

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