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

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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.

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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

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Funding

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

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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
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  2. Thorsten Bach
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  3. Simon Hein
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  4. Andrea Cocci
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  5. Giorgio Ivan Russo
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  6. Thomas R. W. Herrmann
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  7. Christian Gratzke
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  8. Arkadiusz Miernik
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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.

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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.

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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

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

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