Cameron Jones, MD, discusses patient selection for Aquablation

In this video, Cameron C. Jones, MD, of Allegheny Health Network in Pittsburgh, Pennsylvania, discusses how his experience with Aquablation has informed patient selection and treatment planning, including the impact of prostate size and anatomy. He also highlights factors that may favor alternative procedures for benign prostatic hyperplasia (BPH).

Jones explains that his approach to patient selection largely follows established indications for surgical treatment of BPH, including bothersome lower urinary tract symptoms refractory to medical therapy and complications such as bladder stones or urinary retention. He identifies heavily calcified prostates, which can limit ultrasound visualization during treatment planning, and anticoagulation that cannot be safely interrupted as key contraindications. Although Aquablation can be used across a broad range of prostate sizes, Jones says he tends to favor other approaches for very small glands and for very large prostates, particularly those exceeding 200 to 250 cc with a substantial intravesical component.

Jones also explaines how experience with the technology has changed how he evaluates prostate anatomy before treatment. During office cystoscopy, he now pays particular attention to the location and configuration of intravesical prostatic tissue, distinguishing posterior median lobe enlargement from intravesical lateral lobe extension.

“When you plan for the median lobe and you're making your contour, you're largely doing it in the midline sagittal,” he explains. “And so if they have significant intravesical lateral lobe extension, you can't really see it to plan for it. It's a little harder to treat that tissue safely without risking injury to the bladder.”

Jones notes that lateral lobe tissue extending into the bladder may require additional tissue removal during bladder neck treatment, while a small gland with a high bladder neck or prominent median lobe can limit the space available for effective treatment.

For patients with these more challenging anatomic features, Jones may counsel them toward alternative procedures, including transurethral resection of the prostate or GreenLight therapy. He emphasizes that Aquablation remains anatomically flexible, but careful preoperative assessment can help determine whether the technology is the best fit for an individual patient and anticipate areas that may require additional treatment during the procedure.