POD-1.4 WATER vs WATER II 3-year update: Comparing Aquablation therapy for benign prostatic hyperplasia in 30-80cm3 and 80-150cm3 prostates

Anis Assad

Resident
Urology
CHUM

Abstract

WATER vs. WATER II three-year update: Comparing Aquablation therapy for benign prostatic hyperplasia in 30–80 cm3 and 80–150 cm3 prostates

Anis Assad1, David-Dan Nguyen2, Kevin Zorn1, Dean Elterman3, Naeem Bhojani1.

1Division of Urology, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada; 3Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

Some of the results of this abstract were presented at the AUA’s 2021 annual meeting* . *Medical and surgical retreatment rates will be presented for the first time.

Introduction: Surgical options are limited when treating large (>80 cc) prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).[1][2] Aquablation therapy, a waterjet ablative procedure combining image guidance and robotics, is emerging as a safe and effective procedure with a short learning curve.[5][6][7][8] We aimed to compare the outcomes of Aquablation for small-to-moderate (30–80 cc) prostates with the outcomes for large (80–150 cc) prostates at 3-year followup. 

Methods: WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPH in men 45–80 years old with a prostate of 30–80 cc.[5][6] WATER II is a prospective, multicenter, single-arm, international clinical trial of Aquablation in men with a prostate of 80–150 cc.[7][8] We compare 36-month outcomes among 116 WATER and 101 WATER II study subjects undergoing Aquablation.[7][8][9] Students’ t-test or Wilcoxon tests were used for continuous variables and Fisher’s test for binary variables.

Results: International Prostate Symptom Score (IPSS) scores improved from 22.9 and 23.2 at baseline in WATER and WATER II, respectively, to 8.0 and 6.5 at 36 months, with 36-month reductions of 14.4 and 16.3 points, respectively (p=0.247). At baseline, urinary flow rate (Qmax) was 9.4 and 8.7 cc/sec in WATER and WATER II, improving to 20.6 and 18.5 cc/sec, respectively (p=0.552), at 36 months. Improvements in both IPSS and Qmax were immediate and sustained throughout followup. At three years, 98% and 94% of treated patients were BPH medication-free in WATER and WATER II, respectively (p=0.038). At three years, 96% and 97% of treated patients were free from surgical retreatment in WATER and WATER II, respectively (p=0.613).  

Conclusions: Three-year followup demonstrates that Aquablation therapy leads to sustained outcomes, few irreversible complications, and low retreatment rates for the treatment of LUTS/BPH independently of prostate volume.

 

 

 

 

References:

[1] Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol. 2019;202(3):592-598.
[2] Gravas S, Cornu JN, Gacci M, et al. Management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Published online 2019. Accessed November 14, 2021. https://researchportal.helsinki.fi/en/publications/management-of-non-neurogenic-male-lower-urinary-tract-symptoms-lu
[3] Lin Y, Wu X, Xu A, et al. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol. 2016;34(9):1207-1219.
[4] Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53(1):160-166.
[5] Gilling P, Barber N, Bidair M, et al. WATER: A double-blind, randomized, controlled trial of aquablation ® vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199(5):1252-1261.
[6] Gilling P, Barber N, Bidair M, et al. Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial. Can J Urol. 2020;27(1):10072-10079.
[7] Bhojani N, Nguyen DD, Kaufman RP Jr, Elterman D, Zorn KC. Comparison of 100 cc prostates undergoing aquablation for benign prostatic hyperplasia. World J Urol. 2019;37(7):1361-1368.
[8] Zorn KC, Bidair M, Trainer A, et al. Aquablation therapy in large prostates (80–150 cc) for lower urinary tract symptoms due to benign prostatic hyperplasia: WATER II 3‐year trial results. BJUI Compass. Published online October 28, 2021. doi:10.1002/bco2.121
[9] Nguyen DD, Barber N, Bidair M, et al. WATER versus WATER II 2-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30–80-cm3 and 80–150-cm3 Prostates. European Urology Open Science. 2021;25:21-28.



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