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

Dean Elterman; Peter Gilling; Claus Roehrborn; Neil Barber; Vincent Misrai; Kevin C Zorn; Naeem Bhojani; Alexis Te; Mitch Humphreys; Steven Kaplan; Mihir Desai; Thorsten Bach

doi:10.1136/bmjsit-2021-000090

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

BMJ Surg Interv Health Technol. 2021 Jun 23;3(1):e000090. doi: 10.1136/bmjsit-2021-000090. eCollection 2021.

Authors

Dean Elterman¹, Peter Gilling², Claus Roehrborn³, Neil Barber⁴, Vincent Misrai⁵, Kevin C Zorn⁶, Naeem Bhojani⁶, Alexis Te⁷, Mitch Humphreys⁸, Steven Kaplan⁹, Mihir Desai¹⁰, Thorsten Bach¹¹

Affiliations

¹ Surgery, University of Toronto, Toronto, Ontario, Canada.
² Urology, Tauranga Hospital, Tauranga, New Zealand.
³ Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Urology, Frimley Health NHS Foundation Trust, Frimley, Surrey, UK.
⁵ Urology, Clinique Pasteur, Toulouse, France.
⁶ University of Montreal Hospital Center, Universite de Montreal, Montreal, Québec, Canada.
⁷ Urology, Weill Cornell Medical College, New York, New York, USA.
⁸ Urology, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
⁹ Urology, Mount Sinai Medical Center, New York, New York, USA.
¹⁰ Urology, University of Southern California, Los Angeles, California, USA.
¹¹ Urology, Asklepios Westklinikum Hamburg, Hamburg, Hamburg, Germany.

Abstract

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.

Keywords: minimally invasive surgical procedures; natural orifice endoscopic surgery; prostate ablation devices; robotic surgical procedures; urology devices.