Aquablation versus transurethral resection of the prostate: 1 year United States - cohort outcomes.

INTRODUCTION: The purpose of this analysis was to compare Aquablation to transurethral resection of the prostate (TURP) with respect to efficacy and safety at 1 year for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in the United States (U.S.) cohort from the Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue (WATER) study.

MATERIALS AND METHODS: WATER is a double-blinded, multicenter prospective randomized controlled trial for patients with moderate-to-severe lower urinary tract symptoms related to BPH. Men were randomized to TURP or Aquablation. The efficacy and safety outcomes at 1 year were evaluated for the U.S. cohort. The efficacy objective was reduction in International Prostate Symptom Score (IPSS). The safety objective was the occurrence of Clavien-Dindo persistent grade 1 or grade 2 or higher operative complications.

RESULTS: Ninety patients were randomized and treated between December 2015 and December 2016. Change in IPSS at 1 year between Aquablation and TURP was similar (14.5 versus 13.8, respectively, p = 0.7117). The number of subjects experiencing persistent Clavien-Dindo grade 1 or Clavien-Dindo grade 2 or higher adverse events was lower in the Aquablation group compared to the TURP group (20% versus 47% respectively, p = 0.0132). Amongst sexually active subjects, the rate of anejaculation was lower in patients treated with Aquablation than TURP (9% versus 45%, respectively, p = .0006).

CONCLUSIONS: Surgical prostate resection using Aquablation showed improvement in lower urinary tract symptoms at 1 year comparable to TURP, but with a lower risk of adverse events and ejaculatory dysfunction.