Functional and surgical outcomes of Aquablation in elderly men
Brendan Lapointe Raizenne1, David Bouhadana2, Kevin Zorn1, Bilal Chughtai3, Dean Elterman4, Naeem Bhojani1.
1Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; 2Faculty of Medicine, McGill University, Montréal, QC, Canada; 3Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, United States; 4Division of Urology, University Health Network, Toronto, ON, Canada
Introduction: As benign prostatic hyperplasia (BPH) is an age-related process, growing interest in surgical management for elderly men has emerged. Recently, Aquablation was approved for treatment of BPH-associated lower urinary tract symptoms (LUTS). This novel technology uses robotic ultrasound-guided and surgeon-controlled waterjet resection to accurately target prostate tissue. We assessed the differences in functional and surgical outcomes between elderly and young men undergoing Aquablation for LUTS/BPH.
Methods: We retrospectively assessed prospectively collected patient data from the pivotal WATER (NCT02505919) and WATER II (NCT03123250) clinical trials reporting safety and efficacy of Aquablation in the treatment of LUTS/BPH in men 45–80 years old with a prostate between 30 cc and 80 cc, and 80 cc and 150 cc, respectively. Baseline demographics and clinical variables were carefully recorded in an independently monitored database. Men ≥65 years old were defined as elderly while men <65 years old were defined as young.
Results: Of 217 patients included, 83 (38.2%) were young men and 134 (61.8%) were elderly men. Mean age (standard deviation [SD]) was 59.3 (±3.4) years and 71.2 (±4.2) years for young and elderly men, respectively. Baseline demographics and clinical variables were similar for both cohorts. At three years of followup, compared to baseline, elderly men showed similar reductions in total International Prostate Symptom Score (IPSS) (7.68 vs. 7.12 points, p>0.05), IPSS quality of life (QoL) (1.38 vs.1.38 points, p>0.05), and postvoid residual (PVR) (39.9 vs. 42.3 mL, p>0.05), as well as similar increases in maximal flow rate (20.6 vs. 19.3 mL/s, p>0.05) compared to young men. The ejaculatory dysfunction rate was similar for both cohorts (12.0% vs. 9.7%, p>0.05). No patients experienced new-onset erectile dysfunction. Elderly men experienced similar annual retreatment rates compared to young men (1.5% vs. 0.8%, p>0.05).
Conclusions: Elderly men undergoing Aquablation have similar functional and surgical outcomes as young men. Elderly patient BPH surgical counselling should, therefore, consider Aquablation as a treatment option for LUTS/BPH.
