Aquablation, which uses robotically guided waterjets to remove excess prostate tissue, appears to improve lower-urinary-tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) and large prostate glands, researchers report

There are several management options for LUTS/BPH in men with small- to moderate-volume prostate glands, but many of these options are less effective and not recommended for men with significantly enlarged prostates.

Dr. Faysal A. Yafi from the University of California, Irvine, and colleagues present three-month safety and efficacy data from 79 American participants in the WATER II single-arm trial of aquablation for the treatment of LUTS/BPH associated with large prostate volumes (80-150 mL).

International Prostate Symptom Scores (IPSS) declined significantly from 23.7 before treatment to 11.8 one month after treatment and 7.1 after three months, the researchers report in the International Journal of Impotence Research, online July 25.

Quality-of-life scores improved from 4.6 before aquablation to 2.7 and 1.9 at one and three months, respectively. Maximum urinary flow rates and post-void residual volumes also improved significantly in the three months after aquablation.

Two patients required transfusions in association with the procedure, 11% had persistent ejaculatory dysfunction, 6% had incontinence and none had erectile dysfunction after treatment.

Aquablation study

"One of the major limitations of the WATER II trial is that it is a single-arm Aquablation study without any control group, be it placebo or any other well recognized treatment modality for large prostates," the researchers note.

"Longer term data regarding efficacy and safety are necessary to further validate Aquablation as a durable treatment option for men with bothersome LUTS/BPH and large prostates," they conclude.

Dr. Bilal Chughtai from Weill Cornell Medicine, New York, told Reuters Health by email, "This is a promising new technology for men with large prostates that is an alternative to much more invasive therapies. There is a complication rate of 34.1% for grade 2 and 3 complications, which is on par with open or robotic prostatectomy but higher than laser technologies such as HoLEP (Holmium enucleation of the prostate) or PVP (photoselective vaporization)."

"This is one of the first technologies that reduces intersurgeon variability," he said. "There are reportedly high rates of retreatment of larger prostates with varying technologies, and with the utilization of the robotic guidance, it removes a fixed amount of tissue that should give lasting and durable results with larger prostates that can be technically challenging."