Abstract
Purpose
Aim of this systematic review is to evaluate functional outcomes (Qmax, QoL, IPSS, PVR), sexual outcome (erectile dysfunction and anejaculation rate), and adverse events evaluated according to the Clavien–Dindo classification.
Methods
The bibliographic search with the included terms (prostate, benign prostatic hyperplasia, benign prostatic enlargement, lower urinary tract symptoms, water jet dissection, aquablation, Aquabeam®) produced a literature of 32 articles altogether. After removing papers of not interest or articles which the outcomes could not be deduced, nine studies were examined for a total of 664 patients screened.
Results
The functional outcomes, evaluated after water jet dissection, have shown improvement with respect to the baseline in all the selected articles. In the comparison papers with the TURP, the Aquablation has been statistically not inferior regarding functional outcomes. The sexual outcomes have highlighted a better ejaculation rate for water jet dissection than TURP. Regarding the adverse events, water jet dissection documented low rates of adverse events and, in comparison studies, were not statistically superior than TURP.
Conclusions
In our systematic review, the Aquabeam® System for the treatment of LUTS/BPH has proven to be a safe technique that provides functional outcomes comparable to TURP. About sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, other multicenter randomized trials with larger cohorts and longer follow-up are still needed.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Egan KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin North Am. 2016;43:289–97.
Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97.
Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, et al. A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol. 2016;69:94–102.
Zhu Y, Zhuo J, Xu D, Xia S, Herrmann TR. Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol. 2015;33:509–15.
Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67:1066–96.
MacRae C, Gilling P. How i do it: aquablation of the prostate using the AQUABEAM system. Can J Urol. 2016;23:8590–3.
Gilling P, Reuther R, Kahokehr A, Fraundorfer M. Aquablation—image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016;117:923–9.
Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, et al. WATER: a double-blind, randomized, controlled trial of Aquablation® vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199:1252–61.
Desai M, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, et al. WATER II (80–150 mL) procedural outcomes. BJU Int. 2019;123:106–12.
Liberati A, Altman D, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.
Kasivisvanathan V, Hussain M. Aquablation versus transurethral resection of the prostate: 1 year United States—cohort outcomes. Can J Urol. 2018;25:9317–22.
Chughtai B, Thomas D. Pooled aquablation results for American men with lower urinary tract symptoms due to benign prostatic hyperplasia in large prostates (60–150 cc). Adv Ther. 2018;35:832–8.
Zorn KC, Goldenberg SL, Paterson R, So A, Elterman D, Bhojani N. Aquablation among novice users in Canada: a WATER II subpopulation analysis. Can Urol Assoc J. 2019;13:E113–8.
Bach T, Giannakis I, Bachmann A, Fiori C, Gomez-Sancha F, Herrmann TRW, et al. Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort. World J Urol. 2018. https://doi.org/10.1007/s00345-018-2509-y
Desai MM, Singh A, Abhishek S, Laddha A, Pandya H, Ashrafi AN, et al. Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients. BJU Int. 2018;121:945–51.
Yafi FA, Tallman CT, Seard ML, Jordan ML. Aquablation outcomes for the U.S. cohort of men with LUTS due to BPH in large prostates (80–150 cc). Int J Impot Res. 2018;30:209–14.
EAU Guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). 2018. Chap. 7, para 4, p. 47.
Cimino S, Voce S, Palmieri F, Favilla V, Castelli T, Privitera S, et al. Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up. Int J Impot Res. 2017;29:240–3. https://doi.org/10.1038/ijir.2017.30.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Lebdai S, Chevrot A, Doizi S, Pradere B, Delongchamps NB, Benchikh A, et al. Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol. 2018. https://doi.org/10.1007/s00345-018-2368-6.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Reale, G., Cimino, S., Bruno, G. et al. “Aquabeam® System” for benign prostatic hyperplasia and LUTS: birth of a new era. A systematic review of functional and sexual outcome and adverse events of the technique. Int J Impot Res 31, 392–399 (2019). https://doi.org/10.1038/s41443-019-0158-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-019-0158-3
This article is cited by
-
Reasons to overthrow TURP: bring on Aquablation
World Journal of Urology (2021)