Salvage Robotic Water Jet Ablation After Failed Prior Prostatic Urethral Lift Procedure

Gutierrez-Gamez, A, Kahlenberg, Z, González, R

prostate, ablation, waterjet, failed, lift, salvage

Benign Prostatic Hyperplasia (BPH) is a common condition that affects the quality of life in middle-aged men. With the rise of minimally invasive surgical treatments (MIST), men now have more treatment options available. This video abstract highlights the limitations of MIST procedures and how robotic waterjet ablation can improve patients' symptoms and quality of life.

This video presents the case of a 68-year-old male who experiences a weak stream and urgency. Imaging shows an enlarged prostate (126 mL), and an MRI-guided biopsy reveals no malignancy. His Prostate-Specific Antigen (PSA) level is 5.5, with an IPSS score of 7 and a Quality-of-Life score of 4. Uroflowmetry shows a velocity of 10 mL/s, a voided volume of 125 mL, and a post-void residual volume of 56 mL. The patient's goal is to improve urinary symptoms while preserving maximum sexual function.

This video provides a step-by-step guide for performing waterjet ablation on patients with previously placed prostatic urethral lift (PUL) tabs. The procedure begins with the initial setup and flexible cystoscopy, followed by positioning and calibration for waterjet ablation. After the ablation, hemostasis is performed to prevent post-operative bleeding. Prostate inspection is done to remove any remaining PUL tabs. Finally, the prostate is evacuated, and continuous irrigation begins through a Foley catheter inflated to 50 mL for traction.

The video also reviews literature on the outcomes and safety of salvage BPH procedures after MIST, discussing the benefits and limitations of waterjet ablation, particularly after a MIST procedure. This case emphasizes the importance of tailoring patient care to meet the specific needs of this group and highlights numerical values that can help urologists choose the best treatment for their patients.

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   Sanchez DE, Ghoreifi A, Storino Ramacciotti L, et al. The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia. J Endourol. 2025;39(1):50-55. doi:10.1089/end.2024.0370

   Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline amendment 2023. J Urol.2023;10.1097/JU.0000000000003698. https://doi.org/10.1097/JU.0000000000003698

   Thompson, LN; Gardeck, A; Chen, A; Gonzalez, RR. MP62-08 Salvage BPH Procedures Post-Minimally Invasive Treatment—Outcomes And Safety. The Journal of Urology 211(5S):p e1023, May 2024. | DOI: 10.1097/01.JU.0001008904.63948.3b.08