Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies

• Main Authors: Mihir Desai, Dean Elterman, Peter Gilling, Claus Roehrborn, Neil Barber, Vincent Misrai, Kevin C Zorn, Naeem Bhojani, Alexis Te, Mitch Humphreys, Steven Kaplan, Thorsten Bach
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2021-07-01
• Series: BMJ Surgery, Interventions, & Health Technologies
• Online Access: https://sit.bmj.com/content/3/1/e000090.full

Objectives To evaluate functional outcomes following Aquablation in various prostate volume and anatomical subgroups.Design A meta-analysis with individual patient data undergoing Aquablation therapy from four prospective, global, clinical studies that have been conducted with Aquablation; WATER, WATER II, FRANCAIS WATER and OPEN WATER.Setting Australia, Canada, Lebanon, Germany, New Zealand, UK and the USA.Participants 425 men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 1-year follow-up.Interventions Aquablation therapy is an ultrasound guided, robotically executed waterjet ablative procedure for the prostate.Main outcome measures The analyses focus International Prostate Symptom Score (IPSS), uroflowmetry, postoperative Incontinence Severity Index (ISI) and surgical retreatment.Results 425 men with prostates ranging in size from 20 to 150 mL underwent Aquablation therapy. The outcomes from the seven questions in the IPSS questionnaire were grouped by the following; prostates <100 mL, prostates ≥100 mL, prostate anatomy with an obstructive median lobe identifed by imaging, and prostate anatomy without an obstructive median lobe. Regardless of subgroup, all outcomes are consistent and demonstrate a significant improvement from baseline. Specifically, improvements in frequency, urgency and nocturia demonstrated bladder function improvement. Patients entering treatment with severe incontinence, ISI score >4, and regardless of prostate size, showed a reduction in incontinence during patient follow-up. Surgical retreatment due to BPH symptoms occurred in 0.7% (95% CI 0.1%–2.0%).Conclusions Across a variety of prostate anatomies, Aquablation therapy showed remarkable functional improvements following the index procedure. Additionally, men with moderate to severe LUTS/BPH and overactive bladder resulting in urge incontinence showed a reduction in incontinence symptoms postprocedure.