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Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due
Dean Elterman1, Peter Gilling2, Claus Roehrborn3
1Surgery, University of Toronto, Toronto, Ontario, Canada.
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.
