Open Access

ARTICLE

Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH

Peter J. Gilling¹, Neil Barber², Mohamed Bidair³, Paul Anderson⁴, Mark Sutton⁵, Tev Aho⁶, Eugene Kramolowsky⁷, Andrew Thomas⁸, Ronald P. Kaufman, Jr.⁹, Gopal Badlani¹⁰, Mark Plante¹¹, Mihir Desai¹², Leo Doumanian¹², Alexis E. Te¹³, Claus G Roehrborn¹⁴

1 Department of Tauranga Urology Research, Tauranga, New Zealand
2 Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, United Kingdom
3 San Diego Clinical Trials, San Diego, California, USA
4 Royal Melbourne Hospital, Melbourne, Australia
5 Houston Metro Urology, Houston, Texas, USA
6 Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
7 Virginia Urology, Richmond, Virginia, USA
8 Princess of Wales Hospital, Bridgend, Wales, United Kingdom
9 Albany Medical College, Albany, New York, USA
10 Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
11 University of Vermont Medical Center, Burlington, Vermont, USA
12 University of Southern California, Institute of Urology, Los Angeles, California, USA
13 Weill Cornell Medical College, New York, New York, USA
14 Department of Urology, UT Southwestern Medical Center, University of Texas Southwestern, Dallas, Texas, USA
Address correspondence to Dr. Peter J. Gilling, Urology Bay of Plenty, Urology, 850 Cameron Road, PO Box 56, Tauranga 3110 New Zealand

Canadian Journal of Urology 2022, 29(1), 10960-10968.

Abstract

Introduction: To determine if Aquablation therapy can maintain long term effectiveness in treating men with moderate to severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with a baseline prostate volume between 30 and 80 mL at 5 years compared to TURP.
Materials and methods: In a double-blinded, multicenter prospective randomized controlled trial, 181 patients with moderate to severe LUTS secondary to BPH underwent TURP or Aquablation. The primary efficacy endpoint was reduction in International Prostate Symptom Score (IPSS) at 6 months. The primary safety endpoint was the occurrence of Clavien-Dindo persistent Grade 1 or Grade 2 or higher operative complications at 3 months. The assessments included IPSS, Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function (IIEF) and uroflow (Qmax). The patients were followed for 5 years.
Results: The primary safety endpoint was successfully achieved at 3 months where the Aquablation group had a lower event rate than TURP (26% vs. 42%, p = .0149 for superiority). Procedure-related ejaculatory dysfunction was lower for Aquablation (7% vs. 25%, p = .0004). The primary efficacy endpoint was successfully achieved at 6 months, where the mean IPSS decreased from baseline by 16.9 points for Aquablation and 15.1 points for TURP; the mean difference in change score at 6 months was 1.8 points larger for Aquablation (p < .0001 for non-inferiority, p = .1346 for superiority). At 5 years, IPSS scores improved by 15.1 points in the Aquablation group and 13.2 points in TURP (p = .2764). However, for men with larger prostates (≥ 50 mL), IPSS reduction was 3.5 points greater across all follow up visits in the Aquablation group compared to the TURP group (p = .0123). Improvement in peak urinary flow rate was 125% and 89% compared to baseline for Aquablation and TURP, respectively. The risk of patients needing a secondary BPH therapy, defined as needing BPH medication or surgical intervention, up to 5 years due to recurrent LUTS was 51% less in the Aquablation arm compared to the TURP arm.
Conclusions: The improvement in net health outcomes from Aquablation therapy outweigh those offered by a TURP when considering the efficacy benefit along with the lower risk of needing a secondary BPH therapy and avoiding retrograde ejaculation. Following Aquablation therapy, symptom reduction and uroflow improvement at 5 years have shown to be durable and consistent across all years of follow up compared to TURP. Larger prostates (≥ 50 mL) demonstrated a larger safety and efficacy benefit for Aquablation over TURP.

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