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Current Urology Reports

, 20:46 | Cite as

The Role of Aquablation for the Surgical Treatment of LUTS/BPH

  • Hossein Saadat
  • Dean S. EltermanEmail author
Benign Prostatic Hyperplasia (K McVary, Section Editor)
  • 56 Downloads
Part of the following topical collections:
  1. Topical Collection on Benign Prostatic Hyperplasia

Abstract

Purpose of Review

To explore the potential applicability of a novel, heat-free, and robotically controlled ablative therapy for surgical management of benign prostatic enlargement.

Recent Findings

With the emergence of new technology to provide personalized care and overcome the complications associated with options such as TURP, holmium laser enucleation of the prostate, GreenLight laser, or simple prostatectomy, Aquablation has been studied across a variety of prostate volumes.

Summary

The functional outcome of Aquablation seems to be uncompromised by prostate volume. The sexual profile seems superior to TURP and the risk of retrograde ejaculation is lower. The robotic system provides a reproducible ablation, independent of prostate volume, without requiring extensive training for performing the procedure. The mean ablation time in the prostate as large as 150 ml does not exceed 9.1 min, and the blood transfusion rates do not seem to be higher than open prostatectomy.

Keywords

LUTS BPH Aquablation Outcomes 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474–9. http://www.ncbi.nlm.nih.gov/pubmed/6206240.  https://doi.org/10.1016/S0022-5347(17)49698-4. Accessed 31 Jan 2019.
  2. 2.
    Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Weiss N, Goodman P, et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. J Urol. 2007;177(4):1395–400.  https://doi.org/10.1016/j.juro.2006.11.065.
  3. 3.
    Oelke M, Bachmann A, Descazeaud A, et al. members of the EAU Guidelines Panel. EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO) E. Retreived from https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/.  https://doi.org/10.1007/s10126-007-9056-7. Accessed Feb 2019.
  4. 4.
    Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802–13 http://www.ncbi.nlm.nih.gov/pubmed/28646935. Accessed 25 Jan 2019.
  5. 5.
    Porpiglia F, Fiori C, Amparore D, Kadner G, Manit A, Valerio M, et al. Second-generation of temporary implantable nitinol device for the relief of lower urinary tract symptoms due to benign prostatic hyperplasia: results of a prospective, multicentre study at 1 year of follow-up. BJU Int. 2018;123:1061–9.  https://doi.org/10.1111/bju.14608.
  6. 6.
    McVary KT, Rogers T, Roehrborn CG. Rezūm water vapor thermal therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia: 4-year results from randomized controlled study. Urology. 2019;126:171–9.  https://doi.org/10.1016/j.urology.2018.12.041.CrossRefPubMedGoogle Scholar
  7. 7.
    Desai M, Bidair M, Zorn KC, et al. Aquablation for BPH in large prostates (80-150cc): 6-month results from the WATER II trial. BJU Int. 2019;Feb (epub. doi: https://doi.org/10.1111/bju.14703.
  8. 8.
    Geavlete P. Is classical transurethral resection of the prostate, the gold standard endoscopic treatment for benign prostate hyperplasia, in real danger of being replaced? Eur Urol. 2010;58(3):356–8–9.  https://doi.org/10.1016/j.eururo.2010.06.001.
  9. 9.
    Gilling P, Reuther R, Kahokehr A, Fraundorfer M. Aquablation - image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016;117(6):923–9.  https://doi.org/10.1111/bju.13358.CrossRefPubMedGoogle Scholar
  10. 10.
    • Gilling P, Barber N, Bidair M, et al. WATER: a double-blind, randomized, controlled trial of Aquablation® vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199(5):1252–61.  https://doi.org/10.1016/j.juro.2017.12.065 This is the first study comparing Aquablation to TURP.
  11. 11.
    Gilling P, Anderson P, Tan A. Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results. J Urol. 2017;197(6):1565–72.  https://doi.org/10.1016/j.juro.2017.01.056.CrossRefPubMedGoogle Scholar
  12. 12.
    Desai MM, Singh A, Abhishek S, Laddha A, Pandya H, Ashrafi AN, et al. Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients. BJU Int. 2018;121(6):945–51.  https://doi.org/10.1111/bju.14126.
  13. 13.
    Bach T, Giannakis I, Bachmann A, et al. Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort. World J Urol. 2018.  https://doi.org/10.1007/s00345-018-2509-y.
  14. 14.
    •• Desai M, Bidair M, Bhojani N, et al. WATER II (80–150 ml) procedural outcomes. BJU Int. 2019;123:106–112. doi: https://doi.org/10.1111/bju.14360. This is the first study that did not allow prostates smaller than 80 ml to be enrolled and showed applicability of Aquablation in prostates largere than the suggested upper limit for TURP.
  15. 15.
    •• Bhojani N, Nguyen DD, Kaufman RP, et al. Comparison of < 100 cc prostates and > 100 cc prostates undergoing Aquablation for benign prostatic hyperplasia. World J Urol. 2018. doi: https://doi.org/10.1007/s00345-018-2535-9. This study also confirmed the applicability of Aquablation in large prastates.
  16. 16.
    Yassaie O, Silverman JA, Gilling PJ. Aquablation of the prostate for symptomatic benign prostatic hyperplasia: early results. Curr Urol Rep. 2017;18(12):91–1572.  https://doi.org/10.1016/j.juro.2017.01.056.CrossRefPubMedGoogle Scholar
  17. 17.
    Kasivisvanathan V, Hussain M. Aquablation versus transurethral resection of the prostate: 1 year United States - cohort outcomes. Can J Urol. 2018;25(3):9317–22.PubMedGoogle Scholar
  18. 18.
    Gilling P, Barber N, Bidair M, et al. Randomized controlled trial of Aquablation vs transurethral resection of the prostate in benign prostatic hyperplasia: one-year outcomes. Urology. 2018;125:169–73.  https://doi.org/10.1016/j.urology.2018.12.002.
  19. 19.
    Plante M, Gilling P, Barber N, Bidair M, Anderson P, Sutton M, et al. Symptom relief and anejaculation after Aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int. 2018;123:651–60.  https://doi.org/10.1111/bju.14426.
  20. 20.
    Yafi FA, Tallman CT, Seard ML, Jordan ML. Aquablation outcomes for the U.S. cohort of men with LUTS due to BPH in large prostates (80–150 cc). Int J Impot Res. 2018;30(5):209–14.  https://doi.org/10.1038/s41443-018-0045-3.CrossRefPubMedGoogle Scholar
  21. 21.
    Zorn KC, Goldenberg SL, Paterson R, So A, Elterman D, Bhojani N. Aquablation among novice users in Canada: a WATER II subpopulation analysis. Can Urol Assoc J. 2019;13(5):E113–E118.  https://doi.org/10.5489/cuaj.5501.
  22. 22.
    Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53(1):160–8.  https://doi.org/10.1016/j.eururo.2007.08.036.CrossRefPubMedGoogle Scholar
  23. 23.
    Valdivieso R, Hueber P-A, Meskawi M, Belleville E, Ajib K, Bruyere F, et al. Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates. BJU Int. 2018;122(5):873–8.  https://doi.org/10.1111/bju.14208.
  24. 24.
    Kim M, Song SH, Ku JH, Kim H-J, Paick J-S. Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in holmium laser enucleation of the prostate. Int J Impot Res. 2015;27(1):20–4.  https://doi.org/10.1038/ijir.2014.22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Urology, Department of SurgeryUniversity Health Network, University of TorontoTorontoCanada
  2. 2.Toronto Western HospitalTorontoCanada

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