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Objective. The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) treated with prostatic Aquablation.
Materials and methods. We performed a literature search of clinical trials using the MEDLINE, Embase, and Cochrane Library databases and retrieved published works on Aquabl...
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Context 1
... (95% CI, 10.015 to 11.878; p < 0.001) from preintervention to postintervention at 3 months. The pooled studies did not show any evidence of statistical heterogeneity (Cochran's Q = 6.60, df = 6, p = 0.360), with an I 2 value of 9.1%, suggesting that a minimal proportion of the total variation was due to heterogeneity in the between-study variance (Fig. 3). These changes were sustained for 12 months in this ...
Citations
... A further study investigated the role of aquablation in larger prostates (80-150 mL) in 101 men, with significant improvements in IPSS, QoL, Qmax and PVR that was sustained for 3 years with a 3% rate of repeat surgery for LUTS [79]. A recent systematic review corroborates the findings that both IPSS and Q max are significantly improved from baseline following aquablation up to one year whilst appearing to preserve sexual function at 3 months, although the meta-analysis was limited by the extent of the heterogeneity between studies [80]. Post-operative bleeding necessitating a return to theatre or blood transfusion have been reported with Bach et al. reporting a 7.9% rate of return to theatre for haemostasis, a 2 g/dL drop in haemoglobin level prior to discharge and a 2.7% transfusion rate [81]. ...
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient’s symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
Benign prostatic hyperplasia (BPH) is a highly prevalent condition among aging men with significant negative impacts on quality of life. Although multiple surgical treatment modalities exist, there is an ongoing search for minimally invasive techniques to reduce hospital stays and adverse effects without compromising good functional outcomes. Aquablation is a novel minimally invasive surgical technique that combines robotic precision with heat-sparing ablation of obstructing prostate tissue. We describe the setup and mechanism of action of aquablation. A comprehensive literature search for clinical trials and recent meta-analyses was conducted and functional outcomes and adverse effects across multiple studies are summarized here. Aquablation produces comparable (if not superior) outcomes in terms of reduced International Prostate Symptom Score, improved Qmax (comparison of maximum flow velocity), and lower postvoid residuals to transurethral resection of the prostate. These findings are consistently reproduced across multiple clinical trials, including those conducted in the private sector. One major benefit of aquablation is that the risk of injury to the ejaculatory ducts appears to be significantly lower, as evident from the low percentage of cases of postoperative anejaculation issues. Adverse effects are rare, and the most significant one to mention is blood loss requiring transfusion. At present, the overall cost of aquablation is still higher than other methods of treating BPH and this is due to intraoperative and equipment costs. Postoperative care is no more expensive than other methods of BPH treatment. In conclusion, aquablation is a safe and effective surgical modality for the treatment of BPH. It can be offered as an alternative to other surgical modalities for those who wish to spare ejaculatory function. The procedure itself can be easily taught. With further development of this novel technology and increased availability, there is the potential for it to become a much more cost-effective method for surgical treatment of BPH.
Objective:
To analyze the impact of perioperative antithrombotic use on the bleeding outcomes following Aquablation.
Methods:
116 men with who underwent Aquablation as part of the WATER prospective trial (NCT02505919) were assigned to 2 groups based on perioperative antithrombotic status. Antithrombotic cessation and restart timing were based on the surgeon's discretion. Methods of achieving intraoperative hemostasis consisted of no-cautery balloon tamponade or cautery. Primary endpoints included immediate post-operative hematuria rates and changes in hemoglobin. Secondary endpoints included 90-day bleeding complications and non-bleeding post-operative adverse events.
Results:
41 men took antithrombotic medications in the perioperative period while 75 men had no antithrombotic medication. Preoperative hemoglobin levels were comparable between both groups. Post-operative hemoglobin change from baseline (drop of 1.8 ± 1.5g/dl among the antithrombotic group vs. 1.8 ± 1.7 g/dl among the antithrombotic-naïve group) did not differ between both groups (p=0.896). In total, 4 (9.8%) men in the antithrombotic group and 4 (5.3%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo Grade 1 complication (p=0.451) in the 3-month postoperative period. Eight (19.5%) patients in the antithrombotic group and 11 (14.7%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo Grade 2 complication (p=0.601), none of which is associated with bleeding in both groups. No men in either group demonstrated de novo erectile dysfunction. One patient (2.4%) in the antithrombotic group and none in the antithrombotic-naïve group required blood products (p=0.353).
Conclusions:
Aquablation demonstrates comparable post-operative bleeding outcomes and other adverse effects for men with BPH who are on antithrombotic therapy.
