Water ablation therapy relieves lower urinary tract symptoms in BPH patients

14 Feb 2018

The use of Aquablation in surgical prostate resection provides noninferior relief from benign prostate hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) while reducing the risk of sexual dysfunction as compared with transurethral resection of the prostate (TURP), according to data from the WATER study.

A total of 181 patients with moderate-to-severe LUTS associated with benign prostate hyperplasia (BPH) underwent either Aquablation (n=116) or TURP (n=65). Efficacy was evaluated in terms of reduction in International Prostate Symptom Score (IPSS) at 6 months, while safety was assessed with respect to the occurrence of Clavien-Dindo persistent grade 1 or grade 2 operative complications.

Mean total operative time did not significantly differ between Aquablation and TURP (33 vs 36 minutes; p=0.2752). However, resection time was shorter with Aquablation (4 vs 27 minutes; p<0.0001).

At month 6, all patients showed large IPSS improvements, regardless of the surgical approach, with the prespecified noninferiority criterion being met (p<0.0001). The primary efficacy endpoint was achieved in 26 percent of patients in the Aquablation group and in 42 percent in the TURP group. However, Aquablation demonstrated superiority in terms of the primary safety endpoint (p=0.0149).

Researchers noted a more pronounced superior safety and efficacy benefit with Aquablation for larger prostates (50 to 80 mL).

In the subgroup of patients who were sexually active, the rate of anejaculation was significantly lower in the Aquablation group than in the TURP group (10 percent vs 36 percent; p=0.0003).

Studies with longer-term follow-up are warranted to assess Aquablation’s clinical value, researchers said.

Aquablation is a minimally invasive water ablation therapy combining image guidance and robotics for the targeted removal of prostate tissue for the treatment of LUTS as a result of BPH. This approach uses a high-velocity saline stream to allow for a controlled and heat-free ablation of the prostate. [BJU Int 2016;117:923-929]