Comparison of < 100 cc prostates and > 100 cc prostates undergoing aquablation for benign prostatic hyperplasia



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.

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NB: Protocol/project development, data interpretation, manuscript writing/editing. DDN: data interpretation, manuscript writing/editing. kaufman: review. DE: protocol/project development, review. KCZ: protocol/project development, review.

Corresponding author

Correspondence to N. Bhojani.

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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.

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Informed consent was obtained from all patients.

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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).

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  • Aquablation
  • Benign prostatic hyperplasia
  • Large prostate