Surgical options for benign prostatic hyperplasia (BPH) become limited when treating large prostates due to steep learning curves and less effective treatment. Aquablation (AquaBeam System, PROCEPT BioRobotics, Inc., USA) could remedy this. We compare the effectiveness of Aquablation in large prostates between 80 cc and 100 cc and very large prostates > 100 cc.
WATER II (NCT03123250) is a prospective, multicenter, international clinical trial of Aquablation for the surgical treatment of LUTS/BPH in men of age 45–80 years with prostates between 80 cc and 150 cc. Aquablation was performed using the AquaBeam System. The reported analysis compares the subgroup of patients with a baseline prostate size of < 100 cc versus those with a prostate size of > 100 cc. Students’ t test was used for continuous variables and Fisher’s test for ordinal/binary variables.
Of 114 screened patients, 101 meeting eligibility criteria were enrolled at 13 US and 3 Canadian sites between September and December 2017. Mean operative time was 31.2 ± 8 min in the < 100 cc subgroup and 41.7 ± 14.9 min in the > 100 cc subgroup. The average length of stay following the procedure for the < 100 cc subgroup was 1.5 ± 0.7 days versus 1.7 ± 1.1 days for the > 100 cc subgroup. Mean changes in International Prostate Symptom Score (IPSS), IPSS quality of life, and IPSS voiding and storage subscores were substantial, occurring soon after treatment and averaging (at 3 months) 16.5, 2.8, 10.6, and 5.8 points, respectively (all p < 0.0001).
Aquablation clinically normalizes outcomes between patients of the < 100 cc and > 100 cc prostate cohorts. It is safe and effective in patients with large prostate glands (> 100 cc) with a smoother learning curve.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
McAninch JW, Lue TF (eds) (2013) Smith & Tanagho's general urology. McGraw-Hill Medical, New York
Welch G, Weinger K, Barry MJ (2002) Quality-of-life impact of lower urinary tract symptom severity: results from the Health Professionals Follow-up Study. Urology 59(2):245–250. https://doi.org/10.1016/S0090-4295(01)01506-0
McVary KT (2006) BPH: epidemiology and comorbidities. Am J Manag Care 2(5 suppl):122–128. http://www.ncbi.nlm.nih.gov/pubmed/16613526. Accessed 6 Jul 2018
Foster HE, Barry MJ, Dahm P et al (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline. J Urol. https://www.sciencedirect.com/science/article/pii/S0022534718432016?via%3Dihub. Accessed 6 Jul 2018
McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803. https://doi.org/10.1016/j.juro.2011.01.074
Nickel JC, Aaron L, Barkin J, Elterman D, Nachabé M, Zorn KC (2018) Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update. Can Urol Assoc J 12(10):303–312
Gratzke C, Bachmann A, Descazeaud A et al (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109. https://doi.org/10.1016/j.eururo.2014.12.038
Pariser JJ, Pearce SM, Patel SG, Bales GT (2015) National trends of simple prostatectomy for benign prostatic hyperplasia with an analysis of risk factors for adverse perioperative outcomes. Urology 86(4):721–726. https://doi.org/10.1016/J.UROLOGY.2015.06.048
Pariser JJ, Packiam VT, Adamsky MA, Bales GT (2016) Trends in simple prostatectomy for benign prostatic hyperplasia. Curr Urol Rep. 17(8):57. https://doi.org/10.1007/s11934-016-0610-6
Valdivieso R, Hueber PA, Meskawi M et al (2018) Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates. BJU Int. https://doi.org/10.1111/bju.14208
Meskawi M, Hueber P-A, Valdivieso R et al (2017) Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc). World J Urol 35(10):1603–1609. https://doi.org/10.1007/s00345-017-2007-7
Valdivieso R, Hueber P-A, Bruyere F et al (2018) Multicenter international experience of 180 W LBO laser photo-vaporization in men with extremely large prostates (prostate volume > 200cc): is there a size limit? Eur Urol Suppl. 17(2):e191. https://doi.org/10.1016/S1569-9056(18)30978-3
Lin Y, Wu X, Xu A et al (2016) Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 34(9):1207–1219. https://doi.org/10.1007/s00345-015-1735-9
Papachristou DN, Barters R (1982) Resection of the liver with a water jet. Br J Surg 69(2):93–94. http://www.ncbi.nlm.nih.gov/pubmed/7059775. Accessed 6 Jul 2018
Nagele U, Kugler M, Nicklas A et al (2011) Waterjet hydrodissection: first experiences and short-term outcomes of a novel approach to bladder tumor resection. World J Urol 29(4):423–427. https://doi.org/10.1007/s00345-011-0653-8
Gilling P, Reuther R, Kahokehr A, Fraundorfer M (2016) Aquablation—image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 117(6):923–929. https://doi.org/10.1111/bju.13358
Yassaie O, Silverman JA, Gilling PJ (2017) Aquablation of the prostate for symptomatic benign prostatic hyperplasia: early results. Curr Urol Rep. 18(12):91. https://doi.org/10.1007/s11934-017-0743-2
Gilling P, Barber N, Bidair M et al (2018) WATER: a double-blind, randomized, controlled trial of aquablation((R)) vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol 199(5):1252–1261. https://doi.org/10.1016/j.juro.2017.12.065
Desai M, Bidair M, Bhojani N, et al (2018) WATER II (80–150 mL) procedural outcomes. BJU Int. https://doi.org/10.1111/bju.14360
Barry MJ, Fowler FJ, O’Leary MP et al (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148(5):1549–1557
Rosen RC, Allen KR, Ni X, Araujo AB (2011) Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol 60(5):1010–1016. https://doi.org/10.1016/j.eururo.2011.07.053
Rosen RC, Catania J, Pollack L, Althof S, O’Leary M, Seftel AD (2004) Male Sexual Health Questionnaire (MSHQ): scale development and psychometric validation. Urology 64(4):777–782. https://doi.org/10.1016/j.urology.2004.04.056
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Gilling P, Barber N, Bidair M, Anderson P et al (2018) WATER: a double-blind, randomized, controlled trial of aquablation® vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol 199(5):1252–1261
Sorokin I, Sundaram V, Singla N et al (2017) Robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia in large glands: a propensity score-matched comparison of perioperative and short-term outcomes. J Endourol 31(11):1164–1169. https://doi.org/10.1089/end.2017.0489
Monn MF, El Tayeb M, Bhojani N et al (2015) Predictors of enucleation and morcellation time during holmium laser enucleation of the prostate. Urology 86(2):338–342. https://doi.org/10.1016/J.UROLOGY.2015.04.028
Krambeck AE, Handa SE, Lingeman JE (2010) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 183(3):1105–1109. https://doi.org/10.1016/j.juro.2009.11.034
Saluja M, Masters J, Van Rij S (2018) Open simple prostatectomy. In: The Big Prostate. Springer, Cham, pp 143–152
Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P (2016) Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men’s ejaculatory function: time for a bespoke approach? Int J Urol 23(1):22–35. https://doi.org/10.1111/iju.12866
El Tayeb MM, Jacob JM, Bhojani N, Bammerlin E, Lingeman JE (2016) Holmium laser enucleation of the prostate in patients requiring anticoagulation. J Endourol 30(7):805–809. https://doi.org/10.1089/end.2016.0070
Conflict of interest
Study data were entered into an electronic data capture system by site coordinators, were monitored, and source-verified by monitors hired by the study sponsor (PROCEPT BioRobotics).
Human or animal studies
This research involves humans.
Informed consent was obtained from all patients.
About this article
Cite this article
Bhojani, N., Nguyen, D., Kaufman, R.P. et al. Comparison of < 100 cc prostates and > 100 cc prostates undergoing aquablation for benign prostatic hyperplasia. World J Urol 37, 1361–1368 (2019). https://doi.org/10.1007/s00345-018-2535-9
- Benign prostatic hyperplasia
- Large prostate