“I didn’t even think about using the restroom before we got on the plane,' he says. 'I could never have gotten away with that before.”
David Nockowitz, 61, a casino dealer from Atlantic City, is back to living life on his terms after undergoing an innovative new treatment at Penn Medicine called Aquablation® therapy.
The treatment, he says, has been “life changing.”
After being diagnosed with benign prostatic hyperplasia (BPH), and exhausting non-invasive treatment options and seeing no results, his urologist referred David to Penn Medicine. At Penn, he met with urologic surgeon Jennifer E. Lloyd-Harris, MD, MPH, who said he was a good candidate for the procedure.
Aquablation therapy is not widely available across the Greater Philadelphia region, but it is performed by Dr. Lloyd-Harris at Pennsylvania Hospital and by William I. Jaffe, MD at Penn Presbyterian Medical Center.
What is Benign Prostatic Hyperplasia (BPH)?
Benign Prostatic Hyperplasia (BPH) is a common disease in men where an enlarged prostate blocks the flow of urine out of the bladder. It becomes more prevalent with age, although David began experiencing symptoms around age 50. Prior to that, he could sleep for seven hours, uninterrupted, most nights. Gradually, he noticed it became closer to six hours between trips to the restroom. And eventually, just an hour-and-a-half.
“I thought it was part of the aging process,” he says.
His mornings were miserable. He was waking exhausted and, even more frustratingly, unable to urinate. Nockowitz says he typically had to wait at least 10 minutes before he could go. And he rarely felt like he was fully emptying his bladder, which made him uncomfortable at all times.
These are all common symptoms of BPH. While the size of the prostate doesn’t necessarily determine the severity of the symptoms — men with slightly enlarged prostates can have debilitating symptoms, just as men with very enlarged prostates can have only mild symptoms — David says his urologist informed him his prostate had grown to the point that they no longer had the means to treat him.
In August 2021, he developed a significant urinary tract infection that required him to use a catheter for 16 days.
“That was really, really bad,” David says. “It was very painful.”
The next month, he met with Dr. Lloyd-Harris for the first time.
What is Aquablation therapy?
Aquablation therapy is the only treatment of its kind that combines a camera with ultrasound imaging, enabling the surgeon to see the entire prostate in real time.
In clinical studies, men who underwent Aquablation therapy experienced a “very low rate” of incontinence and sexual dysfunction.
The treatment is ideal for men with any size prostate who have tried medical therapy with little success or whose BPH is progressing toward surgical treatment.
During Aquablation therapy, a heat-free waterjet controlled by robotic technology removes the prostate tissue causing symptoms. The prostate is reached through the urethra, so no incision is made. The patient is, however, given anesthesia and is required to remain at the hospital for a night after the procedure for close monitoring.
The gold standard for treating BPH is a surgical procedure called transurethral resection of the prostate — TURP, for short. Many patients, however, choose to avoid surgery, especially as effective alternative treatments have grown in recent years.
Recovery time after Aquablation therapy is faster than it is from TURP; David returned to work about two weeks after his procedure.
“I was really surprised by how quick the recovery period was,” he says.
A year later, David says he’s back to feeling how he did before the onset of his BPH.
Living Life on His Terms Again
In January, David and his wife enjoyed the sun’s warmth during a vacation in Florida. He’s thought less and less about his prostate over the last year.
“I didn’t even think about using the restroom before we got on the plane,” he says. “I could never have gotten away with that before.”
David says he now typically goes four to five hours without urinating. At night, he might wake up once, which has greatly improved his quality of sleep. He’s able to urinate first thing in the morning without any trouble. When he does, he empties his bladder completely.
He describes Dr. Lloyd-Harris as his “saving grace.”
“She was wonderful,” David says. “She made me feel comfortable right from the start, which enabled me to talk openly and honestly about my symptoms and the challenges they posed for me.”
He continues: “She was determined to resolve my condition, and that gave me confidence.”
Dr. Lloyd-Harris is hopeful she has. Among those who have been treated with Aquablation therapy, less than five percent required further treatment at their two-year follow-up. David, however, isn’t all that interested in what the literature says. After struggling for years to maintain hope that his condition would improve, he believes he’s found his solution.