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Urologists share their initial experience with BPH treatment Aquablation


"The learning curve is fairly quick; you can pick this up pretty easily vs some of the other prostate procedures that can take a little bit more time to learn how to use," says Matthew E. Sterling, MD.

In this video, Matthew E. Sterling, MD, and Brian Friel, MD, discuss their initial experience with the Aquablation procedure for the treatment of benign prostatic hyperplasia. Sterling and Friel are urologists with MidLantic Urology.


What have the first few months of offering Aquablation been like for you? What was the learning curve like?

Sterling: This is actually in the operating room, so not in the office. I would say Dr. Friel and I did this together the first few months, which was helpful for both of us. We do have assistance from reps from the company. I tell patients this—nothing that we're doing as urologist is a new technique. The ultrasound is not new; we know how to do ultrasounds. The scoping is not new; we do scopes all the time. The new part is basically using the imaging and the software to guide the scope where to operate. From a learning curve standpoint, there's not much to learn. It tends to be fairly quick in terms of your ability to do the procedure. Now, I think with time, there are going to be some nuances that we'll pick up, for sure. But the learning curve is fairly quick; you can pick this uppretty easily vs some of the other prostate procedures that can take a little bit more time to learn how to use it. My patients so far, I would say, have had similar postops to a TURP, maybe a little bit better for some, but others, I'd say fairly similar. I think it's too soon for me to give a definitive idea of how it's going to be but I imagine the postop is going to be fairly similar to a TURP, maybe slightly better for some patients, but it also could be slightly worse for other patients, depending on the amount of inflammation.

Friel: I agree. The learning curve is interesting, because Dr. Sterling said it perfectly. You're not learning much of anything that's new; it's just doing it in a sequence of steps that you haven't done it in previously. I felt that the reps were very helpful, and I agree with Dr. Sterling that doing it together was also very helpful so that we could just bounce things off each other. We did a lot of preparation ahead of time, making sure that we understood how the technology works, A. for explaining to patients, but B. so that when the first day that we were doing Aquablations came about, we were very comfortable with the steps; it was not something that we're trying to recall how to hook up the arms and do all of these things. We knew the set-up, we knew the sequence of events. And so with that all in place, the learning curve is actually quite minimal. It's different than a lot of other procedures where, if you didn't do them in residency, you may not be overly comfortable learning them in practice. This is different than that, because these are all skills that you already have. And so whether or not you've ever seen it before, it's easy to implement in practice. I agree it's a little early to say what the difference will be or similarities between my TURP patients and Aquablation patients. The one thing I'm very interested to see and track going forward is ejaculatory function, because that tends to be what most of the patients that come to me ask about. If they've already learned about it previously, they ask about it for 2 reasons, 1 being they just like the idea that there's image guidance to this and it's more precise, and number 2, they like the idea that there's an increased chance of preserving ejaculatory function much more so at least as far as the data is concerned than in TURP. But I can't tell you that I've seen that yet because it's a little early. Most of my patients I've seen for more of a either 2-week or 1-month postoperative follow-up and they seem to be following the trajectory of TURPs. And we all know TURPs work well for voiding; that's why it's been around for a long time. And so I certainly expect from a voiding standpoint, this is going to give us similar results.

This transcription was edited for clarity.

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