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Reasons to overthrow TURP: bring on Aquablation

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Abstract

Purpose

In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE).

Methods

A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion.

Results

For small–medium prostates (30–80 mL), Aquablation’s main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80–150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern.

Conclusion

The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.

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Data availability

All the data from our review can be found in published articles in the references.

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Authors and Affiliations

  1. Faculty of Medicine, McGill University, Montreal, QC, Canada

    Iman Sadri, Adel Arezki & David-Dan Nguyen

  2. Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Félix Couture

  3. Division of Urology, Centre Hospitalier de L’Université de Montréal, Montreal, QC, Canada

    Russell Schwartz, Ahmed S. Zakaria & Kevin C. Zorn

  4. Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada

    Dean Elterman

  5. Department of Urology, Hospital Quirón Salud, Barcelona, Spain

    Enrique Rijo

  6. Department of Urology, Clinique Pasteur, Toulouse, France

    Vincent Misrai

  7. Department of Urology, Asklepios Westklinikum Rissen, Hamburg, Germany

    Thorsten Bach

  8. Department of Urology, University of Texas Southwestern Medical Centre, Dallas, TX, USA

    Claus G. Roehrborn

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  1. Iman Sadri
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  2. Adel Arezki
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  4. David-Dan Nguyen
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  5. Russell Schwartz
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  8. Enrique Rijo
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  9. Vincent Misrai
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  10. Thorsten Bach
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Contributions

The literature search, data analysis, and draft were done by IS. All the authors were involved in the revision/critical appraisal of the paper.

Corresponding author

Correspondence to Kevin C. Zorn.

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Conflict of interest

Kevin C. Zorn: Consultant, Investigator (Procept BioRobotics). Dean Elterman: Consultant, Investigator (Procept BioRobotics). Enrique Rijo: Consultant, Investigator (Procept BioRobotics). Thorsten Bach: Consultant, Investigator (Procept BioRobotics). Kevin C. Zorn, Dean Elterman, Enrique Rijo, and Thorsten Bach are consultants and investigators for Procept BioRobotics. Iman Sadri, Adel Arezki, Félix Couture, Ahmed S. Zakaria, David-Dan Nguyen have nothing to disclose.

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Sadri, I., Arezki, A., Couture, F. et al. Reasons to overthrow TURP: bring on Aquablation. World J Urol 39, 2291–2299 (2021). https://doi.org/10.1007/s00345-020-03390-x

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