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Aquablation Compared with Simple Prostatectomy for Prostate Volumes >80 Grams
David Gangwish1, Minhaj Jabeer1, Aidan Kennedy1
1Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA.
Journal of Endourology
|February 21, 2025
Summary
Aquablation (Aqua) offers benefits over simple prostatectomy (SP) in reduced transfusions, hospital stays, and operative times for benign prostatic hyperplasia. However, SP shows better long-term urinary symptom scores and lower retreatment rates.
Area of Science:
- Urology
- Surgical Technology
- Medical Device Evaluation
Background:
- Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) significantly impact quality of life.
- Traditional surgical interventions like simple prostatectomy (SP) have established efficacy but also associated morbidities.
- Aquablation (Aqua) is an emerging minimally invasive technique for BPH treatment.
Purpose of the Study:
- To compare the functional urinary outcomes, adverse events, and retreatment rates of Aquablation (Aqua) versus simple prostatectomy (SP).
- To evaluate the safety and efficacy profiles of these two distinct surgical approaches for BPH management in large prostates (>80 mL).
Main Methods:
- A retrospective chart review of 172 patients undergoing SP or Aqua for BPH from 2017-2023.
- Inverse probability of treatment weighting (IPTW) was used to adjust for baseline characteristic differences, including prostate size.
- Key outcomes analyzed included International Prostate Symptom Score (IPSS), quality of life (QOL), blood transfusions, adverse events (AE), retreatment rates, and postoperative medication use.
Main Results:
- Aquablation demonstrated significantly lower rates of blood transfusions, shorter hospital stays, and reduced operative times compared to SP.
- Simple prostatectomy resulted in superior 1-year International Prostate Symptom Scores (IPSS) and lower retreatment rates.
- Postoperative alpha-blocker use was less frequent after SP, while adverse events were comparable between the two groups.
Conclusions:
- Aquablation offers advantages in perioperative safety and efficiency, including fewer transfusions and shorter procedures.
- Simple prostatectomy provides better long-term symptom control and lower reintervention needs for benign prostatic hyperplasia.
- The choice between Aqua and SP may depend on balancing immediate surgical outcomes with long-term functional results and retreatment considerations.
