Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results

Abstract

To report 12-month safety and effectiveness outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume prostates. METHODS One hundred and one men with moderate-to-severe BPH symptoms and prostate volumes of 80-150 cc underwent a robotic-assisted Aquablation procedure in a prospective multicenter international clinical trial. Functional and safety outcomes were assessed at 12 months postoperatively. RESULTS Mean prostate volume was 107 cc (range 80-150). Mean operative time was 37 minutes and mean Aquablation resection time was 8 minutes. The average length of hospital stay following the procedure was 1.6 days. Mean International Prostate Symptom Score improved from 23.2 at baseline to 6.2 at 12 months (P <.0001). Mean International Prostate Symptom Score quality of life improved from 4.6 at baseline to 1.3 at 12-month follow-up (P <.0001). Significant improvements were seen in Qmax (12-month improvement of 12.5 cc/sec) and postvoid residual (drop of 171 cc in those with postvoid residual >100 at baseline). Antegrade ejaculation was maintained in 81% of sexually active men. No patient underwent a repeat procedure for BPH symptoms. There was a 2% de novo incontinence rate at 12 months, and 10 patients did require a transfusion postoperatively while 5 required take back fulgurations. At 12 months, prostate-specific antigen reduced from 7.1 § 5.9 ng/mL at baseline to 4.4 § 4.3 ng/mL. CONCLUSION The Aquablation procedure is demonstrated to be safe and effective in treating men with large prostates (80-150 cc) after 1 year of follow-up, with an acceptable complication rate and without a significant increase in procedure or resection time compared to smaller sized glands. Clinical-Trials.gov number, NCT03123250. UROLOGY 129: 1−7, 2019.

Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

“…Aquablation has been introduced and data on 80–150 mL prostates show promising early results. However, a reported 38% PSA reduction at 1 year may question the long‐term durability in such gland sizes [27]. Prostate artery embolisation has been tried as well for prostates of >80 mL, with short‐term clinical improvement, but no long‐term data are available [28].…”

Which Anatomic Structures Should Be Preserved During Aquablation Contour Planning to Optimize Ejaculatory Function? A Case-control Study Using Ultrasound Video Recordings to Identify Surgical Predictors of Postoperative Anejaculation

“…[5][6][7][8][9][10][11] Novel ablative therapies, such as Aquablation, have shown promise in reducing EjD after surgery. 12,13 Aquablation is a semi-autonomous, robotically executed, surgeon-guided, high-pressure, heat-free water jet technology leveraging real-time, intraoperative ultrasound visualization of the prostate. 14 A higher proportion of patients undergoing Aquablation compared to TURP maintain antegrade ejaculation in both small 30cc-to-80cc (89%) and large 80cc-150cc (81%) prostates.…”

“…15,23 It is important to note that Aquablation is the only procedure where de novo EjD remained low despite larger prostate sizes (80cc-150cc). 12,15,16 Other surgical modalities available for prostates sizes >80cc, such as PVP, holmium laser enucleation of the prostate , and OSP are associated with postoperative EjD in 60%-80% of cases. 5,10,32 It is possible that the anatomic precision of Aquablation prostate resection helps to avoid damage to structures that are key to preserve ejaculation, such as the verumontanum.…”

Evaluation and treatment of urinary incontinence in the aging male

“…In a study of 331 patients undergoing holmium laser enucleation of the prostate (HoLEP), most common reason for dissatisfaction was experiencing UUI post HoLEP, though was reported in only a minority of patients (transient incontinence in 3 and SUI in 1) [28]. One year follow up results for 101 men undergoing aquablation for BPH with prostates 80-150 cc revealed a similarly low rate of UI (2% de novo incontinence rate at 12 months) [29]. Meta-analysis and systematic review of articles assessing prostatic urethral lift with a minimum follow-up of 24 months revealed transient UUI in a minority of patients that resolved by 2-3 weeks and 1 patient with UUI at 2 years with none requiring anticholinergic medications [30].…”