Aquablation in men with benign prostate hyperplasia: A systematic review and meta-analysis

Abstract

Objective: The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) treated with prostatic Aquablation. Materials and methods: We performed a literature search of clinical trials using the MEDLINE, Embase, and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021. Unpublished works, case reports, conference proceedings, editorial comments, and letters were excluded. Risk of bias was assessed using the ROBINS-I tool. Raw means and mean differences were meta-analyzed to produce summary estimates for pre-versus post-International Prostate Symptom Scores, maximum flow rate, and male sexual health questionnaire value changes. An inverse-variance weighted random effects model was used. Results: Seven studies were included in this review (n = 551 patients) that evaluated various urological parameters. At 3 months, the International Prostate Symptom Scores raw mean difference from baseline was −16.475 (95% confidence interval [CI], −15.264 to −17.686; p < 0.001), with improvements sustained for 12 months. Similarly, maximum flow rate improved by +1.96 (95% CI, 10.015 to 11.878; p < 0.001) from pre to 3 months postoperatively. In addition, the male sexual health questionnaire change pooled effect size was −0.55 (95% CI, −1.621 to 0.531; p = 0.321) from preintervention to postintervention at 3 months. Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias. Conclusions: Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function. Further research is required to confirm these preliminary results.

Aquablation: An overview of a novel, minimally invasive surgical modality to treat benign prostatic hyperplasia

“…Aquablation of the prostate for men with moderate-to-severe LUTS attributable to BPH is safe and effective. The outcomes are consistently reproducible across studies, and a recent systematic review and meta-analysis has shown that the mean IPSS decreases by 16.47 points and that Qmax improves by 10.95 mL/s 19 . Aquablation is at least as good as (if not superior to) TURP at improving LUTS, QoL, and objective urodynamic parameters.…”

“…However, some outcomes exhibited large statistical heterogeneity or publication bias. In summary, aquablation appears to improve LUTS in men with BPH while preserving sexual function, but further research is necessary to validate these preliminary findings 19 .…”

“…Postoperative anejaculation rates are low for aquablation compared with other surgical treatments, and it appears that those with larger prostates are at even lower risk of this. Major bleeding events are uncommon, and the need to return to theater ranges from 0% to 7.9% 19 . Currently, aquablation is still more expensive overall compared with other surgical options for BPH.…”

Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques

“…A further study investigated the role of aquablation in larger prostates (80-150 mL) in 101 men, with significant improvements in IPSS, QoL, Qmax and PVR that was sustained for 3 years with a 3% rate of repeat surgery for LUTS [79]. A recent systematic review corroborates the findings that both IPSS and Q max are significantly improved from baseline following aquablation up to one year whilst appearing to preserve sexual function at 3 months, although the meta-analysis was limited by the extent of the heterogeneity between studies [80]. Post-operative bleeding necessitating a return to theatre or blood transfusion have been reported with Bach et al reporting a 7.9% rate of return to theatre for haemostasis, a 2 g/dL drop in haemoglobin level prior to discharge and a 2.7% transfusion rate [81].…”

A critical evaluation of Optilume® BPH as a novel minimally invasive surgical treatment for the management of lower urinary tract symptoms in men

“…Optilume BPH likewise preserves sexual function with no significant impact on erectile or ejaculatory function. Recent advancements in MIST technologies include Aquablation achieving a −16.475 IPSS at 3 months with sustained results ( 7 ). Similarly, robotically assisted simple prostatectomy has also been demonstrated as an emerging modality in comparison with other simple prostatectomies or endoscopic enucleation techniques ( 8 ).…”