Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and safety of aquablation of the prostate for patients with symptomatic benign prostatic enlargement: a systematic review

  • Invited Review
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this systematic review is to summarize the contemporary literature on aquablation and evaluate its safety and efficacy for the treatment of symptomatic BPE.

Evidence acquisition

A systematic search of English language literature was performed using the PubMed-MEDLINE and Web of Science libraries up to 24 July 2019 by combining PICO (patient population, intervention, comparison, and outcome) terms. We retrieved 16 studies, including 446 patients treated with aquablation eligible for data extraction and analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed.

Evidence synthesis

We identified a randomized controlled trial (RCT) comparing aquablation to transurethral resection of the prostate (TURP) with 6-month, 1-year, and 2-year outcomes, three single-center and single-arm studies, three multicenter and single-arm studies, and five subgroup analyses. Aquablation significantly improved International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL), maximum urinary flow rate (Qmax) and post void residual (PVR) from baseline to last follow-up in all prospective studies. At 2-year follow-up, aquablation showed non-inferior symptom relief compared to TURP, with a lower risk of anejaculation favoring aquablation and no significant differences regarding Clavien–Dindo events. Although a significant hemoglobin drop was reported in all aquablation single-arm studies and when compared to TURP, it did not translate into increased transfusion rates.

Conclusions

Data from the WATER trial demonstrates that aquablation is comparable to TURP in effectively improving symptom scores and functional parameters related to BPE and bladder outlet obstruction. The evidence provided supports the safety of aquablation assessed by procedure-related adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Abbreviations

BPE:

Benign prostatic enlargement

TURP:

Transurethral resection of the prostate

Q max :

Maximum urinary flow rate

IPSS:

International prostate symptom score

IPSS-QoL:

IPSS-quality of life

PVR:

Postvoid residual

PSA:

Prostate-specific antigen

RCT:

Randomized controlled trial

LUTS:

Lower urinary tract symptoms

TRUS:

Transrectal ultrasound

ROBINS-I:

Risk Of Bias In Non-randomized Studies-of Interventions

References

  1. Faber K et al (2015) Image-guided robot-assisted prostate ablation using water jet-hydrodissection: initial study of a novel technology for benign prostatic hyperplasia. J Endourol 29(1):63–69

    Article  PubMed  Google Scholar 

  2. Gravas S, Cornu JN, Drake MJ et al (2018) EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). European Association of Urology

  3. Gilling P et al (2016) Aquablation—image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int 117(6):923–929

    Article  CAS  PubMed  Google Scholar 

  4. Gilling P, Anderson P, Tan A (2017) Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results. J Urol 197(6):1565–1572

    Article  PubMed  Google Scholar 

  5. Pimentel MA, Nair SM, Gilling PJ (2016) Aquablation™: early clinical results. Curr Bladder Dysfunct Rep 11(2):130–133

    Article  Google Scholar 

  6. Taktak S et al (2018) Aquablation: a novel and minimally invasive surgery for benign prostate enlargement. Ther Adv Urol 10(6):183–188

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gilling P 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

    Article  PubMed  Google Scholar 

  8. Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sterne JA et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  10. Misrai V et al (2019) Waterjet ablation therapy for treating benign prostatic obstruction in patients with small- to medium-size glands: 12-month results of the first french aquablation clinical registry. Eur Urol 19:297

    Google Scholar 

  11. Bach T et al (2018) Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort. World J Urol 37(7):1369–1375

    Article  PubMed  Google Scholar 

  12. Desai MM et al (2018) Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients. BJU Int 121(6):945–951

    Article  PubMed  Google Scholar 

  13. Desai M et al (2019) Aquablation for benign prostatic hyperplasia in large prostates (80–150 mL): 6-month results from the WATER II trial. BJU Int 124(2):321–328

    Article  PubMed  Google Scholar 

  14. Desai M et al (2019) WATER II (80–150 mL) procedural outcomes. BJU Int 123:106–112

    Article  PubMed  Google Scholar 

  15. Bhojani N et al (2019) Aquablation for benign prostatic hyperplasia in large prostates (80–150 cc): 1-year results. Urology 129:1–7

    Article  PubMed  Google Scholar 

  16. Gilling P et al (2019) Two-year outcomes after aquablation compared to TURP: efficacy and ejaculatory improvements sustained. Adv Ther 36(6):1326–1336

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gilling P et al (2019) Randomized controlled trial of aquablation vs. transurethral resection of the prostate in benign prostatic hyperplasia: one-year outcomes. Urology 125:169–173

    Article  PubMed  Google Scholar 

  18. Kasivisvanathan V, Hussein M (2018) Aquablation versus transurethral resection of the prostate-1 year United States—cohort outcomes. Can J Urol 25(3):9317–9322

    PubMed  Google Scholar 

  19. Zorn KC et al (2018) Aquablation among novice users in Canada: a WATER II subpopulation analysis. Can Urol Assoc J 13(5):E113–E118

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bhojani N et al (2018) Comparison of < 100 cc prostates and > 100 cc prostates undergoing aquablation for benign prostatic hyperplasia. World J Urol 37(7):1361–1368

    Article  PubMed  Google Scholar 

  21. Yafi FA et al (2018) Aquablation outcomes for the US cohort of men with LUTS due to BPH in large prostates (80–150 cc). Int J Impot Res 30(5):209–214

    Article  PubMed  Google Scholar 

  22. Chughtai B, Thomas D (2018) Pooled aquablation results for american men with lower urinary tract symptoms due to benign prostatic hyperplasia in large prostates (60–150 cc). Adv Ther 35(6):832–838

    Article  PubMed  Google Scholar 

  23. Aljuri N, Gilling P, Roehrborn C (2017) How I do it balloon tamponade. Can J Urol 24(4):8937–8940

    PubMed  Google Scholar 

  24. Yassaie O, Silverman JA, Gilling PJ (2017) Aquablation of the prostate for symptomatic benign prostatic hyperplasia: early results. Curr Urol Rep 18(12):91

    Article  PubMed  Google Scholar 

  25. Plante M et al (2018) Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int 123(4):651–660

    Article  PubMed  Google Scholar 

  26. Madersbacher S (2018) Re: WATER: a double-blind, randomized, controlled trial of aquablation vs transurethral resection of the prostate in benign prostatic hyperplasia. Eur Urol 74(2):233

    Article  PubMed  Google Scholar 

  27. Ploussard G, Tollon C (2016) Re: aquablation—image guided robotically-assisted waterjet ablation of the prostate: initial clinical experience. Eur Urol 69(6):1157–1158

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany

    Rodrigo Suarez-Ibarrola, Simon Hein, Christian Gratzke & Arkadiusz Miernik

  2. Department of Urology, Asklepios Hospital Harburg, Hamburg, Germany

    Thorsten Bach

  3. Department of Urology, University of Florence, Florence, Italy

    Andrea Cocci

  4. Department of Urology, University of Catania, Catania, Italy

    Giorgio Ivan Russo

  5. Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

Authors
  1. Rodrigo Suarez-Ibarrola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thorsten Bach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simon Hein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Cocci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgio Ivan Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas R. W. Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian Gratzke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arkadiusz Miernik
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: RS, AM, and TB. Acquisition of data: RS and TB. Analysis and interpretation of data: RS, AC, GIR, and TRWH. Manuscript drafting: RS. Manuscript editing: TRWH, TB, and AM. Statistical analysis: AC and GIR. Supervision: CG, AM, and TRWH. Critical revision of the manuscript for important intellectual content: all authors.

Corresponding author

Correspondence to Rodrigo Suarez-Ibarrola.

Ethics declarations

Conflict of interest

Arkadiusz Miernik: German Federal Ministry of Education and Research—research funding. German Association of Urology—travel sponsoring. European Association of Urology, Arnhem, NL—travel sponsoring. Verlag Walter de Gruyter, Berlin, DE—royalties. RichardWolf GmbH, Knittlingen, DE—speaker’s fee. KLS Martin, Tuttlingen, DE—advisor. Avatera medical, Jena, DE—advisor. Lisa laser OHG, DE—proctor. Schoelly fiberoptics GmbH, DE—advisor. Optimed GmbH, Ettlingen, DE—advisor. Thorsten Bach: Advisory, speakers honoraries, trial participation, meeting participation: R. Wolf, PROCEPT Biorobotics, Boston Scientific. Thomas RW Herrmann: Company consultant, advisory, patent, royalties, speaker’s honoraries Karl Storz, LISALaser, Advisory, speaker’s honoraries, travel grants, Boston Scientific Advisory, speakers honoraries. The remaining authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suarez-Ibarrola, R., Bach, T., Hein, S. et al. Efficacy and safety of aquablation of the prostate for patients with symptomatic benign prostatic enlargement: a systematic review. World J Urol 38, 1147–1163 (2020). https://doi.org/10.1007/s00345-019-02959-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02959-5

Keywords

Search

Navigation