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WATER II Trial (Aquablation)

  • BPH-Related Voiding Dysfunction (R Lee, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review discusses the role of aquablation therapy for the treatment of benign prostatic hyperplasia in those with prostate volumes between 80 and 150 mL (WATER II trial).

Recent Findings

Aquablation therapy reduced International Prostate Symptoms Scores, improved urinary flow rate, and preserved ejaculatory function in the majority of sexually active patients. Other advantages include faster operative times and a shorter learning curve. Adverse events were low and predominantly centered around bleeding risk.

Summary

Aquablation therapy is effective and safe in the surgical management of large prostates thereby offering alternatives to surgeons and patients alike.

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References

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

  1. Pariser JJ, Packiam VT, Adamsky MA, Bales GT. Trends in simple prostatectomy for benign prostatic hyperplasia. Curr Urol Rep. 2016;17:57.

    Article  Google Scholar 

  2. Brunckhorst O, Ahmed K, Nehikhare O, Marra G, Challacome B, Popert R. Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures. Urology. 2015;86:824–9.

    Article  Google Scholar 

  3. Robert G, Cornu JN, Fourmarier M, Saussine C, Descazeaud A, Azzouzi AR, et al. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int. 2016;117:495–9.

    Article  Google Scholar 

  4. Valdivieso R, Hueber P-A, Bruyere F, et al. Multicenter international experience of 180W LBO laser photo-vaporization in men with extremely large prostates (prostate volume >200cc): is there a size limit? Br J Urol. 2018;17:e191.

    Google Scholar 

  5. •• 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;199:1252–61 The WATER trial established noninferiority of Aquablation to TURP with regards to procedural outcomes and safety profile.

    Article  Google Scholar 

  6. •• Desai M, Bidair M, Bhojani N, Trainer A, et al. WATER II (80–150 mL) procedural outcomes. BJU Int. 2019;123:106–12 The WATER II trial showed that aquablation is effective in treating larger prostate sizes beyond the confines of the prostate size restrictions from the original WATER trial.

    Article  Google Scholar 

  7. •• Desai M, Bidair M, Zorn C, Trainer A, et al. Aquablation for benign prostatic hyperplasia in large prostates (80–150 mL): 6-month results from the WATER II trial. BJU Int. 2019;124(2):321–8 This study was able to capture potential complications beyond the initial procedural reporting of the first WATER II manuscript.

    Article  Google Scholar 

  8. •• Bhojani N, Bidair M, Zorn C, Trainer A, et al. Aquablation for benign prostatic hyperplasia in large prostates (80–150 cc): 1-year results. Urology. 2019;129:1–7 The 1-year published results, which is the most recent to date, shows the durability of the effect of aquablation on the treatment of BPH.

    Article  Google Scholar 

  9. • Bhojani N, Nguyen D, Kaufman R, Elterman D, Zorn K. Comparison of <100 cc prostates and >100 cc prostates undergoing aquablation for benign prostatic hyperplasia. World J Urol. 2019;37(7):1361–8 This paper, based on a subgroup analysis from the WATER II trial showed that procedural differences such as operating time with regards to prostate size do exist, they are not clinically significant.

    Article  CAS  Google Scholar 

  10. Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2013;189:S141–5.

    Article  Google Scholar 

  11. Valdivieso R, Hueber P, Meskawi M, Belleville E, et al. Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates. BJU Int. 2018;122:873–8.

    Article  CAS  Google Scholar 

  12. Monn M, El Tayeb M, Bhojani N, Mellon M, et al. Predictors of enucleation and morcellation time during holmium laser enucleation of the prostate. Urology. 2015;86(2):338–42.

    Article  Google Scholar 

  13. • Zorn K, Goldenberg S, Paterson R, So A, et al. Aquablation among novice users in Canada: a WATER II subpopulation analysis. Can Urol Assoc J. 2019;13(5):E113–8 This study highlights the ease in learning Aquablation for treatment of BPH.

    PubMed  Google Scholar 

  14. • Elterman D, Bach T, Rijo E, Misrai V, et al. Transfusion rates after 800 aquablation procedures using various hemostasis methods. BJU Int. 2020. https://doi.org/10.1111/bju.14990This study showed that prostate size and method of obtaining bladder neck hemostasis were important factors related to bleeding risk and transfusion in Aquablation.

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Author information

Authors and Affiliations

  1. Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Thomas J. De Los Reyes & Dean S. Elterman

  2. Division of Urology, University of Montreal Hospital Centre, University of Montreal, Montreal, Quebec, Canada

    Naeem Bhojani & Kevin C. Zorn

Authors
  1. Thomas J. De Los Reyes
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  2. Naeem Bhojani
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  3. Kevin C. Zorn
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  4. Dean S. Elterman
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Corresponding author

Correspondence to Dean S. Elterman.

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Conflict of Interest

Dr. de los Reyes declares that he has no conflict of interest.

Drs. Elterman, Zorn, Bhojani declares he is an investigator and consultatnt for Procept BioRobotics.

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.

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This article is part of the Topical Collection on BPH-Related Voiding Dysfunction

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De Los Reyes, T.J., Bhojani, N., Zorn, K.C. et al. WATER II Trial (Aquablation). Curr Bladder Dysfunct Rep 15, 225–228 (2020). https://doi.org/10.1007/s11884-020-00596-y

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  • DOI: https://doi.org/10.1007/s11884-020-00596-y

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