Aquablation for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia provides 1-year outcomes similar to those of transurethral resection of the prostate (TURP), with a low rate of procedure-related complications, according to a recent study.

In a double-blind prospective, randomized trial, Peter J. Gilling, MD, of Tauranga Urology Research in Tauranga, New Zealand, and colleagues from 20 international sites randomly assigned 181 men with moderate-to-severe LUTS secondary to benign prostatic hyperplasia (BPH) to undergo either Aquablation—which involves the use of high-velocity waterjets to ablate prostate tissue—or standard electrocautery-based TURP.

At 1 year, BPH symptom score improvements were similar in both groups (a reduction of 15.1 points in International Prostate Symptom Score), Dr Gilling’s group reported in Urology. Both groups experienced marked improvement in mean maximum urinary flow rates: 10.3 and 10.6 cc/sec for Aquablation and TURP, respectively. The mean 1-year decrease in post-void residual volume was 52 and 63 cc in the Aquablation and TURP groups, respectively.

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Also at 1 year, PSA levels had declined by 1 point in both groups. Similar proportions of both groups experienced this decline (Aquablation, 27%; TURP, 30%). Surgical retreatment rates for BPH within 1 year from the procedure were 2.6% in the Aquablation group and 1.5% in the TURP arm, a difference that was not statistically significant.

By month 3, a statistically significant smaller proportion of men in the Aquablation arm than the the TURP group had a persistent Clavien-Dindo grade 1 or grade 2 or higher adverse event (the primary safety endpoint): 26% vs 42%, predominantly retrograde ejaculation. No procedure-related adverse events occurred after month 6, Dr Gilling and his colleagues reported.

The authors noted that the improvements in urinary flow rate and post-void residual observed in their study were similar to those seen for other procedures involve resection of prostate tissue, including laser photovaporization and laser enucleation. Aquablation appeared to result in bigger improvements than techniques not involving resection, such as convective water vapor energy (Rezum) and UroLift.

“Although direct comparisons of our data with those from other trials may not be possible, our data, along with data from other techniques that remove prostate tissue as opposed to altering its structure, suggest that improvements with Aquablation may be larger than those of non-resecting approaches,” Dr Gilling and his colleagues wrote.

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The authors noted that ejaculatory dysfunction is a very common complication of TURP, which may be due to heat-induced damage to the ejaculatory duct. “In Aquablation the risk of ejaculatory function was lower, possibly because of intentional avoidance of tissue destruction at the verumontanum as well as use of a heat-free mechanism to remove tissue.”



Gilling PJ, Barber N, Bidair M, et al. Randomized, controlled trial of Aquablation versus transurethral resection of the prostate in benign prostatic hyperplasia: One-year outcomes. Urology. 2019; published online ahead of print.