The Aquabeam System: a Review
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Purpose of Review
The purpose of this review is to provide a description of the Aquabeam system, the technique more commonly known as aquablation, and review the literature to date including select results from the unpublished WATER study to assess the efficacy and safety of this novel technique for the treatment of male lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO).
Promising outcomes from initial pilot studies and early clinical studies confirming safety and feasibility have led to the large international multi-centre randomised controlled study known as the WATER study. This compared the Aquabeam system to the current gold standard, transurethral resection of the prostate (TURP). This landmark trial has proven that aquablation equals TURP in clinical efficacy and has superior safety outcomes, particularly for larger prostates.
Aquablation is not only a technically feasible and safe procedure for symptomatic male BOO, but has equivalent efficacy to TURP with a better safety profile. Ongoing trials are taking place to confirm aquablation’s role in the spectrum of minimally invasive treatments for male LUTS.
KeywordsBenign prostatic hyperplasia Aquablation Ablation techniques Minimally invasive surgical procedures Transurethral resection of the prostate
Compliance with Ethical Standards
Conflict of Interest
Peter J. Gilling was a consultant to Procept Biorobotics prior to the WATER trial. M. Adrianne Pimentel and Omid Yassaie each declare no potential conflicts of interest.
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–14. Discussion 1314–5. https://doi.org/10.1016/j.eururo.2006.09.019.CrossRefPubMedGoogle Scholar
- 3.Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066–96. https://doi.org/10.1016/j.eururo.2014.06.017.CrossRefPubMedGoogle Scholar
- 10.•• Faber K, de Abreu AL, Ramos P, Aljuri N, Mantri S, Gill I, et al. Image-guided robot-assisted prostate ablation using water jet-hydrodissection: initial study of a novel technology for benign prostatic hyperplasia. J Endourol. 2015;29(1):63–9. Proof of concept of Aquablation with early animal data. This set the stage for subsequent human trials. CrossRefPubMedGoogle Scholar
- 13.• Gilling P, Anderson P, Tan A. Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results. J Urol. 2017;197.6:1565–72. Medium term results from a multi-centre trial. This trial involved new generations of the Aquablation and was pivotal in the evolution of the technique. CrossRefGoogle Scholar
- 14.Roehrborn CG, Gilling P. PNFLBA-03 The water study clinical results–a phase iii blinded randomized parallel group trial of aquablation vs. transurethral resection of the prostate with blinded outcome assessment for moderate-to-severe luts in men with benign prostatic hyperplasia. J Urol. 2017;197.4:e603–4. (Abstract)CrossRefGoogle Scholar
- 15.Clinical Trials.gov Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue II (WATERII). NCT03123250. Available from URL: https://clinicaltrials.gov/ct2/show/NCT03123250 Accessed 21 October 2017.
- 16.Clinical Trials.gov Global Post-Market Registry Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (OPEN WATER). NCT02974751. Available from URL: https://clinicaltrials.gov/ct2/show/NCT02974751?term=open+water&draw=1&rank=1 Accessed 21 October 2017.
- 19.Christidis D, et al. Minimally invasive surgical therapies for BPH: the rise in MIST. Prostate Int. 2017; 5(2):41–6.Google Scholar
- 20.Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384–97. https://doi.org/10.1016/j.eururo.2010.06.005.CrossRefPubMedGoogle Scholar
- 21.Nair SM, Pimentel MA, Gilling PJ. Evolving and investigational therapies for benign prostatic hyperplasia. Can J Urol. 2015;22(Suppl 1):S82–7.Google Scholar