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Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes

Published:December 12, 2018DOI:https://doi.org/10.1016/j.urology.2018.12.002

      ABSTRACT

      Objective

      To report 1-year safety and efficacy outcomes after either Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH)

      Methods

      This double-blinded, multicenter prospective randomized controlled trial assigned 181 patients with BPH-related moderate-to-severe lower urinary tract symptoms to either electrocautery-based prostate resection (TURP) or Aquablation. Efficacy endpoints included reduction in International Prostate Symptom Score and improvement in uroflow parameters. The primary safety endpoint was the occurrence of Clavien-Dindo persistent grade 1 or grade 2 or higher complications.

      Results

      BPH symptom score improvements were similar across groups with 12-month reduction of 15.1 points after TURP or Aquablation. In both groups, mean maximum urinary flow rates increased markedly postoperatively, with mean improvements of 10.3 cc/s for Aquablation versus 10.6 cc/s for TURP (P = .8632). At 1 year, Prostate-specific antigen (PSA) was reduced significantly (P < .01) in both groups by 1 point; the reduction was similar across groups (P = .9125). Surgical retreatment for BPH rates for TURP were 1.5% and Aquablation 2.6% within 1 year from the study procedure (P = not significant (NS)). The rate of late complications was low, with no procedure-related adverse events after month 6.

      Conclusion

      The 1-year outcomes after TURP and Aquablation were similar and the rate of late procedure-related complications was low. (ClinicalTrials.gov number, NCT02505919).
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      References

        • Trueman P
        • Hood SC
        • Nayak US
        • et al.
        Prevalence of lower urinary tract symptoms and self-reported diagnosed “benign prostatic hyperplasia”, and their effect on quality of life in a community-based survey of men in the UK.
        BJU Int. 1999; 83: 410-415
        • Naslund MJ
        • Gilsenan AW
        • Midkiff KD
        • et al.
        Prevalence of lower urinary tract symptoms and prostate enlargement in the primary care setting.
        Int J Clin Pract. 2007; 61: 1437-1445
        • Madersbacher S
        • Marberger M
        Is transurethral resection of the prostate still justified?.
        BJU Int. 1999; 83: 227-237
        • McVary KT
        • Roehrborn CG
        • Avins AL
        • et al.
        Update on AUA guideline on the management of benign prostatic hyperplasia.
        J Urol. 2011; 185: 1793-1803
        • Miano R
        • De Nunzio C
        • Asimakopoulos AD
        • et al.
        Treatment options for benign prostatic hyperplasia in older men.
        Med. Sci. Monit. 2008; 14: RA94-RA102
        • Rassweiler J
        • Teber D
        • Kuntz R
        • et al.
        Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention.
        Eur Urol. 2006; 50 (discussion 980): 969-979;
        • Montorsi F
        • Moncada I
        Safety and tolerability of treatment for BPH.
        Eur Urol Suppl. 2006; 5: 1004-1012
        • Emberton M
        • Neal DE
        • Black N
        • et al.
        The effect of prostatectomy on symptom severity and quality of life.
        Br J Urol. 1996; 77: 233-247
        • 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: 1252-1261
        • Barry MJ
        • Fowler FJ
        • O'Leary MP
        • et al.
        The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association.
        J Urol. 1992; 148 (discussion 1564): 1549-1557;
        • Gilling P
        • Reuther R
        • Kahokehr A
        • et al.
        Aquablation - image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience.
        BJU Int. 2016; 117: 923-929
        • Aljuri N
        • Gilling P
        • Roehrborn C
        How I do it: balloon tamponade of prostatic fossa following Aquablation.
        Can J Urol. 2017; 24: 8937-8940
        • Dindo D
        • Demartines N
        • Clavien P-A
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Li S
        • Zeng X-T
        • Ruan X-L
        • et al.
        Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis.
        PLoS One. 2014; 9e101615
        • Bachmann A
        • Tubaro A
        • Barber N
        • et al.
        180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial–the GOLIATH study.
        Eur Urol. 2014; 65: 931-942
        • McVary KT
        • Roehrborn CG
        Three-year outcomes of the prospective, randomized controlled Rezūm system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia.
        Urology. 2018; 111: 1-9
        • Roehrborn CG
        • Gange SN
        • Shore ND
        • et al.
        The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. study.
        J Urol. 2013; 190: 2161-2167
        • Chughtai B
        • Thomas D
        Pooled Aquablation results for American men with lower urinary tract symptoms due to benign prostatic hyperplasia in large prostates (60–150 cc).
        Adv Ther. 2018; 35: 832-838