Aquablation, the use of high-velocity saline streams to ablate tissue, may offer a new option for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), according to the results of a small, prospective, first-in-man study.
In a non-randomized trial, Peter Gilling, MD, and colleagues at Tauranga Hospital, Tauranga, New Zealand, tested the minimally invasive treatment, which combines image guidance and robotics for the targeted and heat-free removal of prostatic tissue, in 15 men with moderate-to-severe LUTS. Patients received the treatment under general anesthesia. The investigators evaluated patients at 1, 3, and 6 months following aquablation with the AquaBeam system (Procept BioRobotics, of Redwood Shores, Calif).
The mean procedural time was 48 minutes, with a mean aquablation treatment time of 8 minutes. All procedures were technically successful, with no serious or unexpected adverse events (AEs), the investigators reported online ahead of print in BJU International. All patients except one had removal of catheter on day 1, and most patients were discharged on the first postoperative day. No patient required a blood transfusion. The researchers observed no serious 30-day AEs. One patient had a second aquablation treatment within 90 days of the first procedure. The mean International Prostate Symptom Score improved significantly from 23 at baseline to 8.6 at 6 months, Dr. Gilling’s group reported. The maximal urinary flow rate (Qmax) increased from 8.6 mL/sec at baseline to 18.6 mL/sec at 6 months.
In addition, the mean detrusor pressure at Qmax decreased significantly from 66 cm H2O at baseline to 45 cm H2O at 6 months. The mean prostate size at 6 months had decreased by 31% compared with baseline. No cases of erectile dysfunction or urinary incontinence were reported.
“The study confirms that aquablation is a safe and feasible treatment for patients with LUTS due to BPH,” the authors wrote. “The reported AEs were similar to those seen after other minimally invasive procedures, and the risk profile appears appropriate for a BPH therapy. In addition, the improvement in symptoms and urodynamic measures are comparable to those seen with other BPH surgical interventions.”