Aquablation for Benign Prostate Hyperplasia

Abstract

Introduction: Treatment for bladder outflow obstruction secondary to benign prostatic hyperplasia has been evolving. The traditional endoscopic technique of transurethral resection of the prostate has its limitations and, therefore, other methods have been sought. Laser enucleation of the prostate is one of these with superior efficacy but is operator dependent and time consuming during the learning phase.1 Aquablation is a newly introduced technique, utilizing a high-velocity saline jet to ablate prostate adenoma. This technique is a highly targeted hydrodissection using robot assistance and real-time transrectal ultrasound guidance. Materials and Methods: The phase I study was conducted in New Zealand.2 Fifteen patients met the criteria in this single-center nonrandomized trial. The procedure was conducted under general anesthesia. Proprietary instruments were employed. The patients were followed up for 6 months postprocedure and assessed for functional outcomes and complications. Results: The mean age of the patients was 73 years and mean prostate volume was 54 g (27–85 g). Intraoperative technical success was achieved in 100% of cases. Mean ablation time was 8 minutes, whereas mean operative time was 48 minutes. Fourteen patients had urethral catheters removed within 24 hours of the procedure and were discharged. No serious intraoperative or postoperative complications occurred. No patients required blood transfusion and negligible changes in postoperative sodium levels were noted. One patient required a repeat procedure within 90 days. At 6 months, the average reduction in prostate volume was 31%. This corresponded to a significant improvement in functional outcomes: International Prostate Symptom Score improved from 23 to 8.6; quality of life from 5 to 2.5, and Qmax from 8.6 to 18.6 mL/s. There were specifically no new cases of retrograde ejaculation, urinary incontinence, or erectile dysfunction noted. Conclusions: The Aquablation technique for removal of obstructing prostate adenoma is a safe procedure. Although a phase III randomized study is currently underway to examine efficacy, the technique may become a useful addition to the treatments available for benign prostatic hyperplasia. Dr. P.J.G. received payment for the research expenses and support to attend Investigator meetings for this work from Procept Biorobotics Ltd. Mr. M.S. is an employee of PROCEPT BioRobotics. Dr. S.M.N. has no financial interest. The study was funded by PROCEPT BioRobotics. Runtime of video: 6 mins 37 secs