Aquablation Promising for Benign Prostatic Hyperplasia

By Reuters Staff

May 09, 2022

NEW YORK (Reuters Health) - Aquablation appears to be a safe and effective for treatment for lower-urinary-tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), regardless of prostate volume, new data show.

Aquablation using the AquaBeam System (PROCEPT BioRobotics Inc) combines ultrasound imagery with precise robot-controlled, surgeon-guided waterjet ablation to remove prostate tissue.

Pooled three-year follow-up data from the WATER and WATER II studies show aquablation is effective for small to moderate (30 to 80 cc) and large (80 to 150 cc) prostate volumes.

The WATER study compared the safety and efficacy of aquablation with transurethral resection of the prostate (TURP) in men with LUTS/BPH and prostate volumes 30 to 80 cc. WATER II tested aquablation in men with LUTS/BPH and prostate volume 80 to 150 cc.

Dr. Naeem Bhojani of the University of Montreal Hospital Center, in Quebec, Canada, and colleagues compared 36-month outcomes in 116 men from WATER and 101 from WATER II treated with aquablation.

Clinical improvement in BPH based on standardized questionnaires and uroflowmetry measures was "rapidly observed and persevered" at three years coupled with a low rate of both complications and retreatment, they report in Urology.

International Prostate Symptom Score (IPSS) scores improved from 22.9 and 23.2 at baseline in WATER and WATER II, respectively, to 8.0 and 6.5 at three years - reductions of 14.4 and 16.3 points, respectively (P=0.247).

At baseline, urinary flow rate (Qmax) was 9.4 and 8.7 cc/sec in WATER and WATER II and improved to 20.6 and 18.5 cc/sec, respectively (P=0.552) at three years. "Improvements in both IPSS and Qmax were immediate and sustained throughout follow-up," the authors note.

At three years, 98% and 94% of patients in WATER and WATER II, respectively, were free of BPH medication, and 96% and 97% did not require surgical retreatment.

Aquablation led to an average PSA reduction of 32% and 45% in WATER and WATER II, respectively, which is comparable with other ablative techniques such as TURP, photovaporization and Rezum, the authors say.

"Aquablation relies on the use of image guidance and robotic execution, increasing precision and reducing surgeon-to-surgeon variability. Moreover, the great majority of surgeons in both WATER and WATER II trials had no prior experience with Aquablation procedure which highlights its short learning curve," they point out.

The WATER and WATER II clinical trials are funded by PROCEPT BioRobotics. Six authors report financial ties to the company.

SOURCE: Urology, online April 21, 2022.