Aquablation for dual burden disease - BPH and chronic prostatitis/chronic pelvic pain syndrome: a single-center...

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for approximately 90-95% of prostatitis cases and is defined by pelvic pain or discomfort persisting for at least three of the preceding six months in the absence of identifiable infection. Despite its high prevalence, management remains challenging, and no standardized treatment approach has been established. In men with concomitant benign prostatic hyperplasia (BPH), bladder outlet obstruction may contribute to symptom persistence or severity. Aquablation, a robot-assisted, waterjet-based therapy used for the treatment of BPH, enables precise, heat-free prostatic tissue removal and may provide symptomatic benefit in this clinical setting.

We performed a prospective pilot study including 20 men aged 45 years or older with diagnoses of both BPH and CP/CPPS who reported clinically significant symptoms, defined as an NIH-CPSI score of 8 or greater at screening. All patients underwent Aquablation between July and December 2024 and were evaluated at 1, 3, and 6 months following the procedure. Primary outcome measures included changes in International Prostate Symptom Score (IPSS) and NIH-CPSI, with assessment across pain, urinary, and quality-of-life (QoL) domains.

Significant improvements in both IPSS and NIH-CPSI scores were observed by 3 months postoperatively (p < .001), with further modest and sustained improvements noted at 6 months. The greatest symptom reductions were seen in pain and quality-of-life domains. No major adverse events occurred during the study period.

Aquablation was associated with improvement in both lower urinary tract symptoms and CP/CPPS-related symptom measures in men with coexisting BPH and CP/CPPS. These preliminary findings support further investigation of Aquablation as a potential treatment option for selected patients with this challenging clinical overlap.