The water jet used to treat men who always need the toilet

Patient: Paolo Fattore, 55, a restaurateur from Surrey, underwent the bold treatment


About 18 months ago I started having to get up in the night to go to the loo — most nights it was only once but sometimes I’d be up two or three times.

After a few months, I went to see my GP, in August 2016, and had a PSA test which checks your levels of a protein that is linked to an enlarged prostate, and to prostate cancer.

I’d had a PSA test five years earlier so my GP was able to compare the results: there wasn’t much of a difference.

So I was just given some advice about not drinking late at night, not to drink too much alcohol or caffeine, which can irritate the bladder, and to come back if my symptoms got worse.

The next month, on holiday in Sicily with my wife, Elaine, I started needing the loo a lot during the day as well as the night. I was lying by the pool and kept feeling the urge to ‘go’ every 20 minutes. It was frustrating and irritating.

When I went back to my GP, I was prescribed pills to relax my bladder so it wouldn’t keep contracting and trying to pass urine.

When this didn’t help, he said he’d refer me to a urologist but an appointment would take a few weeks to arrange.

It was frustrating as I am usually very active — as well as going to the gym about three times a week, I cycle about 40 miles every weekend — but with my bladder problems I had to cut my exercise right down.

One Sunday, two months after my holiday and before my urologist’s appointment, things took a turn for the worse. I was still feeling the urge to go every 20 minutes, but I couldn’t pass any urine.

I was in agony — my bladder felt at bursting point but I couldn’t do anything about it. I telephoned 111 for advice and they told me to go straight to my local A&E at Frimley Park Hospital in Surrey.

The doctors fitted me with a catheter, to drain my bladder. It was such a relief.

'I was in agony — my bladder felt at bursting point but I couldn’t do anything about it,' said of his symptoms before the ground-breaking treatment

‘I was in agony — my bladder felt at bursting point but I couldn’t do anything about it,’ said of his symptoms before the ground-breaking treatment

A few hours later I was allowed home, still wearing the catheter, which involved having a bag strapped to my knee that I had to empty regularly. I had to have this while I waited for tests to find out why I couldn’t urinate.

Luckily, I had my appointment with the urologist Neil Barber a couple of weeks later. He ran some tests, including checking the strength of my urine stream; I also had a bladder ultrasound scan.

Mr Barber said I had an enlarged prostate, which was pressing on my urethra and preventing my bladder emptying properly, sometimes blocking the flow completely.

 My symptoms improved immediately. I wasn’t in pain, there were just some traces of blood in my urine for a few weeks afterwards.

The choices included having surgery to remove part of the prostate, and laser treatments using intense heat to remove the excess tissue. He also mentioned a clinical trial into another procedure from the U.S. using a robot-controlled waterjet to trim the prostate.

It was just as safe as the other options but had a quicker recovery time and the risk of sexual function problems and incontinence afterwards was dramatically cut.

It sounded ideal, but it was only available on the NHS as part of the trial, which I was too late to join. I’d been in such agony, I asked if I could have it done at the private part of the hospital.

I had the procedure in February this year. It took about half an hour under general anaesthetic. I had it done on a Sunday and I was discharged the next day and back at work on Wednesday.

My symptoms improved immediately. I wasn’t in pain, there were just some traces of blood in my urine for a few weeks afterwards.

I have full control again, and I don’t need to get up in the night. I’ve had no side-effects whatsoever. Within three weeks I was back in the gym and two weeks later I was cycling again.


Neil Barber is a consultant urological surgeon at Frimley Health NHS Foundation Trust in Surrey.

Bothersome urinary symptoms caused by an enlarged prostate, known medically as benign prostate enlargement, affect as many as half of men over the age of 50.

The prostate, a small gland that lies under the bladder and surrounds the urethra, is usually the size of a walnut, but in most men it will begin to grow from early middle age, thought to be due to hormonal changes.

If it grows too much it can press on the urethra, obstructing the flow of urine and causing symptoms such as needing to urinate more frequently or difficulties emptying the bladder fully.


The main risk, though small, is of bleeding during the procedure.

Bhaskar Somani, a consultant urological surgeon at Southampton General Hospital says: ‘This is a new minimally invasive procedure. 

There is data to show that it is clinically safe and there is no risk to sexual function. But because it is so new, there is no long-term follow up data.’

In severe cases, like with Paolo, it can cause a complete blockage, so patients will need a catheter.

Doctors can prescribe drugs to relax the prostate and bladder muscle or to shrink the prostate. This can improve symptoms by 20 to 30 per cent, but doesn’t work for everyone.

If these fail, surgery is the only alternative. Traditionally the option has been transurethral resection of the prostate (TURP), where electricity was used to cut away part of the prostate.

But this can damage muscles and nerves, resulting in ejaculatory problems, impotence and, rarely, urinary incontinence.

Typically it can take up to a month to recover and as long as three months for complete improvement in waterworks symptoms. There are less invasive alternatives such as laser treatment or inserting tiny beads to cut off blood supply to kill some of the tissue.

With Aquablation we use a high-powered water jet to destroy the tissue — and only 7 per cent of cases experience sexual function issues.

The water jet is targeted by a robot, so it is very precise, and because this procedure doesn’t use heat there is less damage to healthy tissue.

Once the patient is under general anaesthetic, I insert a single probe into the urethra — it contains a fibre optic telescope that relays images so I can see what I’m doing and another device that delivers the water and drainage for the removed tissue.

I start by pressing a foot pedal, which triggers the robot to aim precisely at the prostate tissue I’ve mapped out to be destroyed.

The whole procedure usually takes under an hour. The urinary symptoms will ease over the following month and many patients are back to normal activities after one to two weeks.

Results of the global trial called Water, which included patients at three UK NHS centres — Frimley Park Hospital, Addenbrooke’s in Cambridge and The Princess of Wales Hospital in Bridgend — are due to be published soon.

They demonstrate that Aquablation has the same safety and efficacy results as standard surgery but with a significantly lower risk of sexual function problems. The results will be put to NICE for its approval in England and Wales. Another NHS trial, called Open Water, is under way at Frimley Park Hospital and at centres in Europe.

The treatment costs around £9,000 privately


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This means that although it may relieve the symptoms while you’re using it, when you stop, the body’s reaction to this can make the symptoms much worse. Always use as directed.

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