Treatment of Benign Prostatic Hyperplasia Using Waterjet Ablation Device: Functional and Endoscopic Results After Two Year Follow-up

Introduction: Aquablation is a new surgical procedure used for patients with moderate-to-severe LUTS caused by BPH and it consists of the ablation of prostate tissue using waterjet robotic device and guided by a transrectal ultrasound image. Being relatively a new approach and a possible substitution to the gold standard for certain individuals, it’s safety and efficacy need to be studied along with an evaluation of the long-term effects. Objectives: The main objectives of this study are to assess the feasibility, safety, and efficacy of Aquablation procedure performed using Waterjet Aquabeam system to treat BPH-related symptoms. A secondary aim was the morphological assessment of the overall prostatic urethra and bladder cavity through a cystoscopy performed 3 months post-operatively. Materials and Methods: Patients with indication to undergo prostate surgery for BPH-related LUTS who met the following inclusion criteria were asked to join this experimental study and were followed-up at 1, 3, 6, 12 and 24 months post-operatively. Results: A total of 109 patients were enrolled in the study. Primary feasibility and safety endpoint was reached as all the Aquablation procedures were uneventful, and no intraoperative complications were observed. Mean ablative time was at 5.6 ± 2.1 min, mean operative time at 62.5 ± 14.8 min, hospital stay at 4.6 ± 1.2 days and time to catheter removal at 3.2 ± 2.2 days. Overall, 22 early postoperative complications were recorded and were graded as I or II according to the Clavien–Dindo system except for 2. Hematuria was the most common complication (9.1%), recorded within 6 hours after the intervention, and a total of 2 patients underwent a reintervention due to arterial bleeding from the prostatic lodge. All objective and subjective measures of urinary function showed statistically significant improvements from baseline levels at all assessment points. This includes an increase in Qmax and a drop in IPSS, IPSS-QoL, and PVR along with the maintenance of SHIM and MSHQ-EjD scores post-operatively and over the period of 24 months. Finally, cystoscopy evaluation at 3 months interval of follow up revealed overall satisfactory post-procedure endoscopic outcomes. Conclusions: The combination of robotics, real-time ultrasound guidance, and heat-free tissue removal of Aquabeam resulted in a new feasible, safe, and effective approach for the treatment of BPH-related LUTS at least until 24 months postoperatively; moreover, sexual, and ejaculatory functions were fully preserved. Endoscopic evaluation performed 3 months after treatment reveals a good safety profile in terms of ejaculatory anatomical structures preservation as well as good results in terms of hydro-ablation efficacy.