The following article features coverage from the American Urological Association (AUA) 2019 meeting. Click here to read more of Renal & Urology News’ conference coverage.

CHICAGO—Aquablation treatment for benign prostatic hyperplasia (BPH) clinically normalizes regardless of prostate size, according to new study findings presented at the 2019 American Urological Association annual meeting. Men with larger prostates, however, have an increased risk for some complications.

David-Dan Nguyen, MD, of McGill University in Montreal, and Naeem Bhojani MD, of the University of Montreal Hospital in Canada, tested the AquaBeam system, an ultrasound-guided, robotically executed waterjet ablative procedure by PROCEPT BioRobotics, in 2 double-blind, international trials. WATER (Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue; W-I; NCT02505919) compared Aquablation with transurethral resection of the prostate (TURP) in 116 men 45 to 80 years old with prostate sizes between 30 and 80 mL. WATER II (W-II; NCT03123250) tested Aquablation in 101 men of the same ages with larger prostate sizes more than 80 and up to 150 mL.

In W-I, mean prostate volume decreased from 54.1 mL to 37.2 mL, a 31% decrease, at 3 months after Aquablation treatment. In W-II, mean prostate volume decreased from 107.4 to 63.2 mL, a 44% decrease.

Continue Reading

Men treated with Aquablation fared similarly in several important areas, whether their prostate size was smaller or larger. Mean operative time was 33 vs 37 minutes in W-I vs W-II. Average length of stay was 1.4 vs 1.6 days, respectively. International Prostate Symptom Score (IPSS) fell to 7.8 in W-I and 6.2 in W-II patients by 12 months. Qmax was 21.1 vs 19.4 mL/sec and post-void residual 45 vs 51.2 mL in W-I vs W-II patients, respectively, at 12 months.

Men with larger prostate sizes had higher risks for complications, however. By 3 months, Clavien-Dindo grade 2 or higher events occurred in more W-II than W-I participants: 34.7% 19.8%. Ten W-II patients vs 1 W-I patient required a postoperative blood transfusion. Ejaculatory dysfunction occurred in 19% of W-II patients compared with 7% of W-I patients. Urinary incontinence developed in 4% (2% de novo) of W-II patients and none of the W-I patients.

“Aquablation is effective independent of prostate size and clinically normalizes outcomes between patients with a 30 cc to 80 cc prostate and patients with an 80 cc to 150 cc prostate treated for lower urinary tract symptoms due to BPH with an expected increase in the risk of complications,” Dr Nguyen told Renal & Urology News. “It is effective in patients with any sized prostate glands up to at least 150 mL with acceptable complications.”

The study was funded by PROCEPT BioRobotics.

Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.


Nguyen DD, Bhojani N. Water vs water II: Aquablation therapy for benign prostatic hyperplasia. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract MP01-01.