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Webinar Transcript

Note: This transcript has been edited and paraphrased for flow and clarity by removing verbal fillers, correcting minor transcription errors, and reformatted for ease of reading while preserving the original technical and clinical information. Please note that these transcriptions should not be relied on as medical advice. Please view the video and schedule an appointment with Dr. Cicic to learn more about your condition.

Webinar Introduction

CJ Peters (Georgia Urology): Good evening, everyone. My name is CJ Peters with Georgia Urology. We are waiting a few seconds as people in the waiting room trickle into the live seminar. Thank you for spending your evening with us; we have a great presentation lined up on BPH (enlarged prostate), with a particular focus on a device called Aquablation. This is an innovative and non-thermal treatment for an enlarged prostate.

Leading our discussion tonight is Dr. Arman Cicic, a board-certified urologist and recognized expert in Aquablation. Before joining Georgia Urology, he was the highest-volume Aquablation practitioner in Wisconsin. He is a highly knowledgeable physician with great information to share.

Before we begin, a few notes on the webinar:

• You will see a QR code in several places during the presentation. Scanning this will take you to our online scheduling page.
• We have opened priority slots for this webinar; when scheduling, type “Webinar” as your reason for the visit to see Dr. Cicic sooner than usual.
• Feel free to ask questions using the chat feature at any time. These questions are anonymous and will only be seen by Dr. Cicic, myself, and representatives from our partner, Procept, the makers of the Aquablation device. We will dedicate time at the end to answer them.

Dr. Cicic, I will hand it over to you.

Understanding BPH: The “Plumbing Issue”

Dr. Arman Cicic: Thank you, CJ. I am Dr. Arman Cicic, and I appreciate you joining me to discuss a topic near and dear to my heart. We will discuss why enlarged prostate happens, what you can do about it, and your treatment options, including a detailed look at the Aquablation procedure.

The prostate gland is an organ that sits beneath the bladder and is contiguous with it. The bladder attaches to the prostate, which has its own urethra, the channel through which you urinate. Think of it like a donut around a garden hose. The garden hose is the channel, and the donut is the prostate. As we age, that donut enlarges, resulting in a “plumbing issue”.

Common BPH Symptoms:

• Weak urinary stream.
• Trouble starting to urinate.
• Waking up at night to urinate.
• A sudden urge to go.
• Any symptom that interferes with your quality of life.

Importantly, an enlarged prostate does not mean you have prostate cancer. This condition affects one in two men over age 50, and by age 80, there is an 80% chance of having it. Like your ears and nose, the prostate does not stop growing throughout your lifetime.

Why does it grow? The main factor is time. The prostate responds to testosterone exposure; it is small at birth and enlarges with age. Its ultimate size is determined by your “blueprints,” much like your hand or foot size, and it often runs in families. Additionally, muscles at the junction of the bladder and prostate become tighter as we age.

BPH Treatment Landscape

Lifestyle and Medication

I always discuss lifestyle first. There are things you can do without medication to improve symptoms.

• Supplements: Pumpkin seed oil has been shown to improve symptoms, but many other commercial supplements are ineffective.
• Fluid Strategies: Stopping fluid intake one or two hours before bed can help reduce nighttime trips to the bathroom.
• Medications: Pills like Tamsulosin (or any “–osin” medication) work by relaxing the muscles at the bladder-prostate junction. Others can modestly shrink the prostate.

Surgical Procedures

Procedures vary from minimally invasive to more invasive.

• TURP (Transurethral Resection of the Prostate): Often called the “Roto-Rooter,” this has been around since the 1960s. Done under general anesthesia, a scope shaves out prostate tissue. It is proven and effective, but often results in retrograde ejaculation (dry orgasm) in 65–90% of patients.
• UroLift: A minimally invasive procedure using clips to open the prostate. It takes about five minutes and usually doesn’t require a catheter. However, it is not suitable for all prostate sizes, and one in eight men may need further treatment within five years.
• Rezum: An office-based procedure using steam to shrink the prostate. You are awake for this, and it takes 5–10 minutes. It is less effective for larger prostates and typically requires a catheter for one week.
• Aquablation: The Robotic Water Jet Treatment
  Aquablation is a robot-guided water jet treatment. It uses high-pressure water to remove tissue with no heat and no cutting, maximizing benefits while minimizing side effects like sexual dysfunction.

How it Works

This procedure is performed in the hospital under general anesthesia, and 95% of patients go home the same day.

• Dual Visualization: We use both a small camera (cystoscope) through the urethra and a transrectal ultrasound. This allows us to see the prostate in 3D, ensuring we see every part we are treating.
• Mapping: We contour the treatment specifically to your prostate’s size and shape.
• The Water Jet: A heat-free jet, about one-fourth the width of a hair, acts like a controlled pressure washer. It penetrates exactly 2.5 centimeters—enough to create an open channel but not enough to damage surrounding structures.
• Preservation: We specifically identify and avoid the ejaculatory protection zone and the urinary sphincter. Because we can see the sphincter directly, the rate of incontinence with Aquablation is nearly zero.

Patient Consultation and Recovery

Consultation Questions: When seeing your urologist, ensure they have “multiple tools in their tool belt” and can discuss conservative strategies alongside various procedures. Most patients are candidates for multiple options. Key considerations include:

• Prostate size and shape.
• The importance of preserving sexual function.
• Preference for office-based vs. OR-based procedures (anesthesia).
• Insurance coverage.

Recovery expectations: Any prostate procedure involves about a month of recovery. You aren’t bedridden, but you may experience urgency, temporary blood in the urine, or mild burning. Water intake is the most critical factor in reducing post-procedure side effects.

Question & Answer Session

Q: When is the best time to see a urologist?
Dr. Cicic: When it causes “bother”. If you are planning trips around rest stops or avoiding social events because of your bladder, it is time. The bladder is a muscle; if you wait until you are just “dribbling,” that muscle may be permanently damaged.

Q: What about patients on blood thinners?
Dr. Cicic: This is a multidisciplinary decision. Most procedures require stopping blood thinners briefly. For very large prostates, we can sometimes perform Prostate Artery Embolization (PAE) first to decrease blood supply and minimize bleeding risk during Aquablation.

Q: What defines a “large” prostate?
Dr. Cicic: An average prostate is 25–30 grams (walnut size). A “large” prostate is generally 35–40 grams and above. However, symptoms depend on where the growth occurs—internal growth causes more symptoms than external growth.

Q: Does the procedure change the ejaculate?
Dr. Cicic: The prostate makes fluid that helps sperm travel; 90% of ejaculate comes from the prostate. With Aquablation, we aim to preserve forward ejaculation, unlike TURP, which usually results in dry orgasms.

Q: How long does the relief last?
Dr. Cicic: Aquablation and TURP fall into the 10-plus-year durability category. Minimally invasive options like UroLift or Rezum are typically in the 5–10 year range.

Q: Can Aquablation be done after other procedures?
Dr. Cicic: Absolutely. I frequently perform Aquablation on patients who previously had a UroLift. We can see and account for previous work using ultrasound. The only major exception is patients who have had radiation for prostate cancer, as that causes irreversible tissue changes.

Q: Does BPH elevate PSA levels?
Dr. Cicic: Yes, a larger prostate produces more PSA enzyme. We look at PSA density to determine if a high score makes sense for the size of the prostate. We always rule out cancer via MRI or biopsy before proceeding with BPH treatment if PSA is elevated.

Closing Remarks

CJ Peters (Georgia Urology): Thank you, Dr. Cicic. You will receive an email in a few days with a link to this recording. You can use the QR codes to schedule with Dr. Cicic or any of our urologists.

Dr. Cicic: Thank you all for your time. Remember, you are in charge of your health; make an informed decision that fits your life. Have a great night.