Waterjet ablation effective for treating benign prostatic obstruction

By Will Boggs MD

NEW YORK (Reuters Health) - 9/8/2019

Waterjet ablation appears promising for relieving benign prostatic obstruction in men with small- to medium-sized glands, according to results from the French Aquablation Clinical Registry.

"Aquablation is a simple robotic procedure," Dr. Vincent Misrai from Clinique Pasteur, in Toulouse, France, told Reuters Health by email. "It seems that the learning curve is very short."

Dr. Misrai and colleagues in the FRANCAIS WATER trial report the perioperative and 12-month functional outcomes of 30 men (median age, 68 years) with small- to medium-sized prostates after aquablation by three different surgeons without previous experience with the technique.

The technique employs real-time image-guided endourological tissue ablation using a high-velocity waterjet controlled robotically.

The median operative time was 30.5 minutes, with an average resection time of four minutes.

During the six-month follow-up, the median International Prostate Symptom Score (IPSS) improved by a mean 15.6 points (from 18.5 points at baseline to three points at follow-up), the researchers report in European Urology, online July 4.

These improvements persisted at month 12.

Maximum urinary flow (Qmax) and postvoid residual (PVR) also showed significant improvement at 12 months, especially among men with an elevated PVR at baseline.

Erectile function, as measured by the International Index of Erectile Function (IIEF), decreased slightly or remained stable over time.

Eight men (26.7%) had ejaculatory dysfunction at follow-up, but there were no reports of incontinence, erectile dysfunction, or retreatment for BPH symptoms.

"One has to keep in mind that the more the urologist will relieve the prostatic obstruction, the more durable will be the urinary improvement, but to the detriment of ejaculatory function," Dr. Misrai said. "More and more patients want nowadays to balance between lower-urinary-tract symptoms (LUTS) and sexuality when the time comes for the surgery."

"Further data are needed to confirm the findings of the present report," the researchers caution.

Dr. Peter Gilling from Tauranga Hospital, in Tauranga, New Zealand, who has also reported his experience with aquablation of the prostate, told Reuters Health by email that "it's good for small- to medium-sized prostates. (It has) a minimal learning curve and a short procedure time, and it's safe and effective."

He added that "bleeding remains an issue for large glands," citing a 10% transfusion rate in glands larger than 80 g in another study.

PROCEPT BioRobotics, which manufactures the Aquabeam system used in the study, funded the research. The authors report no conflicts of interest.

SOURCE: https://bit.ly/2OjsbMQ

Eur Urol 2019.

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