Aquablation: a novel and minimally invasive surgery for benign prostate enlargement

Abstract

Aquablation is a minimally invasive surgical technology for benign prostate enlargement, which uses high-pressure saline to remove parenchymal tissue through a heat-free mechanism of hydrodissection. Early results show this to be a promising surgical strategy with a strong morbidity profile and reduced resection time. This review serves to provide an overview of the technique and evaluate its safety and efficacy.

An Update on Minimally Invasive Surgery for Benign Prostatic Hyperplasia: Techniques, Risks, and Efficacy

“…A robotic-assisted novel technique, Aquablation utilizes high-pressure saline to dissect prostatic tissue under transrectal ultrasound guidance [7,21,43]. Once resection is complete, cauterization can be used to initiate hemostasis.…”

“…Because careful patient selection is a necessary ingredient for successful therapy, patients should be assessed for inclusion and exclusion criteria, listed in Table 5 [43]. Inclusion criteria include LUTS refractory to medical therapy, age over 50, IPSS>12, Qmax≤12 mL/ s, and prostate size 25 to 80 mL.…”

“…The primary advantages of Aquablation include a resection time of under 10 minutes, preservation of sexual function and urinary continence, and avoidance of thermal damage (which seems to be the reason for the reduction in urinary symptoms) [21,43,44]. With only one double blind RCT to date, lack of consistent Level 1 evidence and long-term follow-up pose the biggest disadvantages to this procedure [45].…”

“… IPSS: international prostate symptom score, LUTS: lower urinary tract symptoms, Qmax: maximum urinary flow rate, UTI: urinary tract infection, PVR: postvoid residual. Adopted from Taktak et al (Ther Adv Urol 2018;10:183–8) [ 43 ]. …”

Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia

“…20 Further prospective studies should include assessment of cost effectiveness of Rezum in comparison with other minimally invasive treatments, including cost of procedure, treatment of AEs, potential retreatment costs and patient lost work days. 21,22 Further considerations and research The Rezum system is an exciting and novel minimally invasive therapy for treating BPH, which thus far has demonstrated strong evidence of clinical effectiveness with a potential wide scope of use with limited drawbacks. However, it is important to consider limitations in the current literature when assessing this novel treatment.…”