Related Experiment Video
Updated: Mar 24, 2026
Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser
Published on: May 9, 2018
Image-Guided Robotic-Assisted Waterjet Ablation of Prostate (Aquablation) Versus Convective Water Vapor Thermal
Dolev Perez1, Ariel Mamber1, Michael Pasherstnik1
1The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Purpose:
Aquablation and Rezūm are established minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) in men with moderate-sized prostates. However, direct real-world data comparing outcomes of these techniques in prostates <80 g remain limited. This study aimed to evaluate and contextualize perioperative and functional outcomes of Aquablation and Rezūm in a prospective, nonrandomized cohort.
Methods:
We conducted a prospective, nonrandomized comparative cohort study between 2023 and 2025 at a single tertiary center. Treatment allocation was based on the patient's informed preference following standardized counseling. Men with moderate-to-severe lower urinary tract symptoms and prostate volume <80 g were included. Outcomes included the International Prostate Symptom Score, quality of life (QoL), irritative symptoms, urinary continence, sexual function, perioperative parameters, complications, and retreatment. Between-group comparisons were exploratory and interpreted descriptively due to baseline differences.
Results:
A total of 428 patients were analyzed, including 324 who underwent Aquablation and 104 who underwent Rezūm. Baseline characteristics differed between groups, with Aquablation patients being older and having larger prostates and higher comorbidity burden. Both procedures resulted in significant and durable improvements in lower urinary tract symptoms and QoL. Aquablation demonstrated numerically greater symptom improvement and faster reduction in irritative symptoms, while Rezūm was associated with shorter operative time and same-day discharge. Erectile and ejaculatory function were largely preserved in both cohorts. Perioperative complication and retreatment rates were low and comparable.
Conclusion:
In this real-world, nonrandomized cohort, both Aquablation and Rezūm provided meaningful and durable symptom relief with preservation of sexual function in men with prostates <80 g. Given baseline imbalances and patient-preference-based allocation, outcomes should be interpreted as descriptive of real-world performance rather than as definitive comparative superiority. These findings support both modalities as effective minimally invasive options, with treatment selection guided by patient characteristics, expectations, and resource considerations.
