AI assisted prostate surgery helps men reclaim their lives

A robotic water jet assisted by AI is helping men with enlarged prostates regain their quality of life, with one patient saying the treatment gave him "a normal life again".

Cheltenham General Hospital has become the south west's centre of excellence for NHS Aquablation, attracting patients from across the region and beyond for the pioneering treatment.

The procedure uses a high-pressure water jet to remove excess prostate tissue and surgeons say it can preserve sexual function and continence while offering faster recovery times than traditional surgery.

Andy Ocock, who spent nearly a year having to wear a catheter, said: "The quality of my life is unrecognisable to what it was before."

Surgeons say the procedure, which treats benign prostatic hyperplasia (BPH), a condition affecting more than four million men over 50 in England, has transformed care for many patients.

For consultant urologist, Jeremy Nettleton, the equipment has been game-changing, allowing him to treat more patients in a day then ever before.

Using ultrasound imaging, surgeons map the enlarged prostate before programming where the water jet should remove tissue.

An AI system trained on more than 100,000 previous procedures suggests a treatment plan, although the surgeon makes the final decision.

"Essentially it's using a high speed pressure washer under ultrasound imaging to very accurately wash out some of the prostate tissue," he said.

"It's pretty fierce, it's up to 8,000 psi (pounds per square inch), but it's really controlled so it's accurate within a millimetre and I can see what it's doing on the ultrasound.

"So it's not like unleashing a pressure washer on a patio and not knowing what it's going to do, it's not like that at all. It's very controlled and it's very precise."

Traditional surgery, known as Transurethral Resection of the Prostate (TURP), removes tissue using heat or cutting tools and can involve longer recovery times.

Ocock, 57, from Cheltenham, spent nearly a year wearing a catheter after his enlarged prostate left him unable to control his bladder.

The condition stopped him running and cycling, activities which had always been an important part of his life.

When doctors offered him Aquablation, he felt it was the better option.

"The classic procedure, the way it was described to me, was that we're going to take your prostate and we're going to core it like an apple," he said.

"So the fact that some guy's going to shoot me with a water laser seemed like a better option to me."

During the operation, Nettleton used ultrasound images to assess the enlarged prostate, which measured well over 100cc.

"We'd say 80 is large. His is well over 100. So really large. We're going to try and remove about 80% of that tissue," he said.

Aquablation has proved so successful in Cheltenham that the hospital is now attracting patients from across the UK. Hundreds of operations have been carried out so far.

Ian Kemp, 67, from North Cornwall, chose the procedure after suffering urinary infections linked to an enlarged prostate for around 20 years.

He said the infections could be "pretty debilitating and very sudden" and had become increasingly difficult to treat.

His operation took less than an hour and he was back home in Cornwall the next day.

"The recovery has been far better than I anticipated or hoped it could be really," he said.

"I very quickly felt like I'd had nothing done. I was back doing things much more swiftly than I ever thought I would be able to."

Kemp said the infections had gone and he was feeling optimistic about the future.

For many patients, the lower risk of complications is a key reason for choosing Aquablation, and Nettleton hopes more surgeons will begin offering the treatment.

"The literature says there's 0% chance of new erectile dysfunction after this procedure, and for procedures that remove tissue that's very unusual.

"It also preserves ejaculation in up to about 90% of patients.

"You might see 90% of men having a change in ejaculation with the older techniques.

"And then from a continence perspective, what we call stress incontinence, leaking when you're coughing, is less than half a percent. So really, really low."

Although Ocock's recovery took longer than expected because of the size of his prostate, he said the procedure had transformed his life.

"The enjoyment and novelty of being able to live a normal life still hasn't worn off," he said.

"The quality of my life is unrecognisable to what it was before. I can just decide what I want to go and do and go and do it, I don't have to think about anything else.

"I've had to relearn certain bodily functions, which has been interesting as a bloke in my 50s. You feel like a child again for a while, but I'm almost there now."

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