Aquablation Therapy Now Available for Prostate Conditions

Speaker 1: Welcome back. Look, guys, let's get a little candid here. Prostate issues are really common, especially as men age, but there's good news about treatments. There's a brand new one, and Dr. Ali Kasraeian is leading the way, and he is right here with us. Back to the show. Good to see you.

Dr. Ali Kasraeian: Great to be here. Congratulations.

Speaker 1: Thank you, man. I appreciate that. It's a lot of fun. We're going to have our kids on together. Yours is a few months ahead of mine, and we're going to have them on together and do some segments.

Dr. Ali Kasraeian: Seven months, crawling, teeth.

Speaker 1: We'll do some of those segments coming up, but right now, we're talking about prostate issues, and you're leading the charge in this, revolutionizing the way people get treatment for not cancerous stuff, but Aquablation therapy.

Dr. Ali Kasraeian: Yeah. So this is a treatment for BPH, benign prosthetic hyperplasia. So guys that have trouble urinating. So the bladder does two things, it fills, and it empties, and in men, there's a prostate below the bladder. So after the age of 40, all of our prostates grow. How much they grow and how much they bother you really depends on the individual. Sometimes they can grow quite big. And once you evaluate it, one of the treatments is to open up that obstruction. So think about your prostate as an orange.

Speaker 1: Okay.

Dr. Ali Kasraeian: You have the outside rind, which is typically where prostate cancer lives. It's called the peripheral zone. And then you have the middle portion, which is the fruit that blocks things. This procedure allows us to use an idea of using imaging like the ultrasound that you see here, measures the middle portion of the prostate, sees what you have to open up, the fruit, and then uses a water jet technology to unravel and open up that whole channel. And that ablation step that you see right there takes five minutes, regardless of the size of the prostate.

Speaker 1: And that's just water? That's just a water jet?

Dr. Ali Kasraeian: It's a very, very advanced technology of how the water jet if you put your finger right up to it, it can hurt your finger. A few centimeters away, it's like a mist that you get.

Speaker 1: It's like a pressure washer.

Dr. Ali Kasraeian: Yeah, it's amazing. So historically, what we would do, the standard of care for BPH and obstruction that you want to open up is a TURP, transurethral resection of the prostate, rotor rooter type procedure.

Speaker 1: Yeah.

Dr. Ali Kasraeian: Imagine you got your fruit. You go in with a spoon and carve out the fruit portion, leaving the rind behind. It opens up the channel. If someone has a very big prostate, you can actually surgically open it up with an incision or a robotic technique where you scoop out that fruit.

Here, regardless of size, you can do this with water jet technology, marrying 3D multidimensional imaging. You're doing an ultrasound. You look in the bladder with a telescopic camera. So you're looking at two views. You know where your sphincter is, so incontinence rates are low.

Speaker 1: Yeah.

Dr. Ali Kasraeian: You can look at the ejaculatory ducts, so the effects on ejaculation are lowered four times lower than the other procedures. And what we have found is with two great studies called the WATER I and the WATER II study have found that compared to the TURP, the outcomes are similar with regards to the positive impact on urination, but the side effects are lower. And for the bigger prostates where you would do a procedure called the simple prostatectomy, this can replace that with a minimally invasive option, and people go home the next day.

Speaker 1: Is this for the cases, because you hear about prostate issues where you are getting up all the time at night, getting up every other hour to have to go to the bathroom, but you're not going, there's not much coming out.

Dr. Ali Kasraeian: So it depends. So, imagine plumbing. As a urologist, when we think of the bladder, the bladder fills and it empties. Here when the bladder muscle is squeezing to create a stream, if there's a big prostate blocking the way, then-

Speaker 1: The bladder can't squeeze. It stops.

Dr. Ali Kasraeian: Or it has to squeeze harder. So the muscle gets thickened. So first, you may notice a weaker stream. You may have to strain. Then you may start going more frequently, more urgently. You get an urge and have to race to the bathroom, or you wake up at night. And so these can become bothersome. They can affect the ability of your bladder to empty. Sometimes it pushes real hard for a long time and says I quit. I can't push hard enough, and you retain urine. That can affect your kidneys. You can have blood in the urine. Those types of things can be affected in the long term effects.

Most people come to see a urologist because they're having trouble with emptying their bladder from a symptom standpoint. They're going more often, getting an urge to go. The stream is not what it used to be. This allows us, after a work-up, to give a minimally invasive option for people, regardless of how big their prostate is. And I'm very excited about how this replaces our treatment for the bigger prostates because instead of an actual surgical procedure with incisions, we can give a minimally invasive option where the people go home the next day.

Speaker 1: Yeah. That's got to be the... And so how long have you been doing this procedure?

Dr. Ali Kasraeian: A colleague of mine named Matt Ercolani in South Florida, we did the first cases outside of clinical trial in April. And then we just did six cases here in Jacksonville, FL.

Speaker 1: So it's really new.

Dr. Ali Kasraeian: Yeah. It's got a lot of European and Australian studies backing it. There are US studies that are ongoing. We're collecting data to make sure that this is a good procedure as we learn about it, but the science is behind it, the data's behind it. And it's been tried and true in the studies that have been done to date. And people have done many, many, many, many cases in the hundreds of approaching thousands as we do more and more of these with great outcomes.

Speaker 1: So the folks out there watching us right now, that may be having prostate issues. Are you the only guy in town doing this, or should they ask about this?

Dr. Ali Kasraeian: So it's the PROCEPT AquaBeam Aquablation. If you're interested in it, obviously call our clinic with this. Me and Dr. Ercolani are probably going to be the only people in Florida and the Southeastern part of the United States for a while, as we were really early adopters of this, and it's a great technology. And I think there'll be more in the time to come. But first, this is a brand new technology with great science behind it and European and Australian data that's more than 2 – 3 years old.

Speaker 1: Yeah. Anytime you can reduce the recovery time and the invasive procedures into something much simpler, that's better for the patient, right?

Dr. Ali Kasraeian: Our goal is to get great outcomes from what the procedure's trying to do, and then we are always trying to be as minimally invasive as possible so that you have fewer side effects and get people back to their day to day living as quickly as possible. I think this is going to revolutionize how we manage BPH.

Speaker 1: That's the goal. Congrats on that, man.

Dr. Ali Kasraeian: Thank you.

Speaker 1: Congrats.

Dr. Ali Kasraeian: Appreciate it.

Speaker 1: Always leading the charge here. Dr. Kasraeian, appreciate you being here. For more information on Dr. Kasraeian, you can head to Dr. Kasraeian's website, which is Kasraeianurology.com. Or you can listen to him live and call into his radio show, The Conversation.