Assessing Micturition, Sexual Function, and Endoscopic Outcomes One Year After Aquablation: a Single Center Prospective Study

Overview

Journal World J Urol

Specialty Urology

Date 2024 Dec 9

PMID 39653839

Authors

Daniele Amparore

Sabrina De Cillis

Alberto Quara

Michele Sica

Michele Ortenzi

Federico Piramide

Paolo Verri

Enrico Checcucci

Alberto Piana

Michele Di Dio

Matteo Manfredi

Cristian Fiori

Stefano De Luca

Francesco Porpiglia

Affiliations

Soon will be listed here.

Abstract

Introduction: Morphological changes in the prostatic urethra and bladder cavity resulting from Aquablation treatment are still unknown. This study aims to assess the safety and efficacy of Aquablation within one-year post-surgery, focusing on both functional and endoscopic outcomes.

Methods: Prospective enrollment of patients undergoing Aquablation (10/2018-04/2023) included those with baseline International Prostate Symptom Score (IPSS) ≥ 10, prostate volume from 40 to 80 mL, and Qmax ≤ 12 mL/s. Functional outcomes were evaluated at 1, 3, 6, and 12 months using uroflowmetry (Qmax), and dedicated questionnaires. Cystoscopy at three months assessed ablation quality on a Likert scale (1-poor; 5-excellent). Measurements included cavity length post-treatment and preserved prostatic tissue length at the apex. Additional evaluations encompassed veru-montanum preservation, presence of residual fluffy tissue or mucous flaps, ureteral orifices and bladder trigone injuries.

Results: Out of 109 enrolled patients, one-year follow-up displayed significant improvements in Qmax (+ 103.08%), IPSS (-86.36%), and IPSS-QoL (-80.00%). Aquablation had no impact on erectile function and continence, preserving ejaculation in 96.3%. Of the 106 patients undergoing cystoscopy, prostatic urethra patency was satisfactory to perfect in 96.2%, with a median cavity length of 24 ± 8.2 mm. Residual median lobe was found in 11.3%, without significant impact on micturition outcomes. Positive outcomes included minimal fluffy tissue and mucosal flaps, and well-preserved ureteral meatuses, verumontanum, and bladder trigone.

Conclusions: Aquablation showed efficacy in solving urinary symptoms with minimal impact on ejaculation up to one year post-surgery. A three-month post-surgery endoscopic evaluation supports its safety, efficacy, and conformity with the ablative planning.

References

Lim K . Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017; 4(3):148-151. PMC: 5717991. DOI: 10.1016/j.ajur.2017.06.004. View

Creta M, Colla Ruvolo C, Longo N, Mangiapia F, Arcaniolo D, De Sio M . Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol. 2020; 73(1):59-71. DOI: 10.23736/S2724-6051.20.03678-4. View

Brown C, van der Meulen J, Mundy A, OFlynn E, Emberton M . Defining the components of a self-management programme for men with uncomplicated lower urinary tract symptoms: a consensus approach. Eur Urol. 2004; 46(2):254-62. DOI: 10.1016/j.eururo.2004.02.008. View

Sun Y, Peng B, Lei G, Wei Q, Yang L . Study of phosphodiesterase 5 inhibitors and α-adrenoceptor antagonists used alone or in combination for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Minerva Urol Nefrol. 2019; 72(1):13-21. DOI: 10.23736/S0393-2249.19.03408-8. View

Xie C, Zhu G, Wang X, Liu X . Five-year follow-up results of a randomized controlled trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate. Yonsei Med J. 2012; 53(4):734-41. PMC: 3381470. DOI: 10.3349/ymj.2012.53.4.734. View

Cornu J, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C . A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2014; 67(6):1066-1096. DOI: 10.1016/j.eururo.2014.06.017. View

Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel M . EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013; 64(1):118-40. DOI: 10.1016/j.eururo.2013.03.004. View

Zambon A, Nguyen T, Fourcade A, Segalen T, Saout K, Deruelle C . Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors. Prostate Cancer Prostatic Dis. 2023; 27(3):500-506. DOI: 10.1038/s41391-023-00770-3. View

Roehrborn C, Chin P, Woo H . The UroLift implant: mechanism behind rapid and durable relief from prostatic obstruction. Prostate Cancer Prostatic Dis. 2021; 25(1):79-85. PMC: 9018420. DOI: 10.1038/s41391-021-00434-0. View

10.

Amparore D, De Cillis S, Schulman C, Kadner G, Fiori C, Porpiglia F . Temporary implantable nitinol device for benign prostatic hyperplasia-related lower urinary tract symptoms: over 48-month results. Minerva Urol Nephrol. 2023; 75(6):743-751. DOI: 10.23736/S2724-6051.23.05322-3. View

11.

Checcucci E, Veccia A, De Cillis S, Piramide F, Volpi G, Amparore D . New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes. Eur Urol Open Sci. 2021; 33:28-41. PMC: 8473553. DOI: 10.1016/j.euros.2021.08.009. View

12.

Sibona M, Destefanis P, Vercelli E, Secco S, Gontero P, Cindolo L . Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs. Prostate Cancer Prostatic Dis. 2023; 26(3):475-482. DOI: 10.1038/s41391-023-00686-y. View

13.

Cornu J, Zantek P, Burtt G, Martin C, Martin A, Springate C . Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol. 2023; 83(6):534-547. DOI: 10.1016/j.eururo.2023.02.028. View

14.

Manfredi C, Arcaniolo D, Spatafora P, Crocerossa F, Fusco F, Verze P . Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications. Minerva Urol Nephrol. 2021; 74(4):389-399. DOI: 10.23736/S2724-6051.21.04530-4. View

15.

Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T . Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022; 29(1):10960-10968. View

16.

Fiori C, Checcucci E, Gilling P, Amparore D, Volpi G, De Cillis S . All you need to know about "Aquablation" procedure for treatment of benign prostatic obstruction. Minerva Urol Nefrol. 2020; 72(2):152-161. DOI: 10.23736/S0393-2249.20.03654-1. View

17.

Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T . Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes. Urology. 2018; 125:169-173. DOI: 10.1016/j.urology.2018.12.002. View

18.

Plante M, Gilling P, Barber N, Bidair M, Anderson P, Sutton M . Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int. 2018; 123(4):651-660. DOI: 10.1111/bju.14426. View

19.

Oumedjbeur K, Corsi N, Bouhadana D, Ibrahim A, Nguyen D, Matta I . Aquablation versus TURP: 5-year outcomes of the WATER randomized clinical trial for prostate volumes 50-80 mL. Can J Urol. 2023; 30(5):11650-11658. View

20.

Pimentel M, Yassaie O, Gilling P . Urodynamic Outcomes After Aquablation. Urology. 2019; 126:165-170. DOI: 10.1016/j.urology.2019.01.020. View