Open Access

ARTICLE

Aquablation versus TURP: 5-year outcomes of the WATER randomized clinical trial for prostate volumes 50-80 mL

Kussil Oumedjbeur¹, Nicholas J. Corsi², David Bouhadana³, Ahmed Ibrahim⁴, David-Dan Nguyen⁵, Imad Matta⁴, Adel Arezki³, Iman Sadri³, Tawfik Elsherbini⁶, Naeem Bhojani⁴, Dean S. Elterman⁵, Bilal Chughtai⁷, Brian T. Helfand⁸, Alexander P. Glaser⁸, Vincent Misrai⁹, Steven Kaplan¹⁰, Peter Gilling¹¹, Neil Barber¹², Mihir Desai¹³, Gopal H. Badlani¹⁴, Alexis E. Te⁷, Claus G. Roehrborn¹⁵, Kevin C. Zorn⁴

1 Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
2 Wayne State University School of Medicine, Detroit, Michigan
3 Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
4 Division of Urology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
5 Division of Urology, University of Toronto, Toronto, Ontario, Canada
6 Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
7 Department of Urology, Weill Cornell Medical College, New York, New York, USA
8 Division of Urology, NorthShore University HealthSystem, Evanston, Illinois, USA
9 Department of Urology, Clinique Pasteur, Toulouse, France
10 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
11 Department of Urology, Bay of Plenty District Health Board, Tauranga, New Zealand
12 Department of Urology, Frimley Park Hospital, Frimley, United Kingdom
13 Institute of Urology, University of Southern California, Los Angeles, California, USA
14 Department of Urology, Wake Forest University, Winston Salem, North Carolina, USA
15 Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
Address correspondence to Dr. Kevin C. Zorn, Division of Urology, Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal, QC, H2X 3E4 Canada

Canadian Journal of Urology 2023, 30(5), 11650-11658.

Abstract

Introduction: To report the 5-year efficacy and safety of Aquablation compared with transurethral resection of the prostate for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia in men with prostate volumes 50-80 mL.
Materials and methods: In a large double-blinded, multicenter, and prospective randomized controlled trial, 96 randomized men with 50-80 mL prostates who underwent Aquablation or transurethral prostate resection were prospectively identified for subgroup analysis. Follow up was performed for up to 5 years. The primary efficacy endpoint was the reduction in International Prostate Symptom Score (IPSS) at 6 months. The primary safety endpoint was the occurrence of Clavien-Dindo (CD) postoperative complications grade 1 persistent and grade 2 or higher at 3 months.
Results: Both groups had comparable baseline characteristics. Reduction in IPSS score was significantly higher in the Aquablation group across 5 years of follow up (-14.1 vs. -10.8, p = 0.02). The Aquablation group achieved a significantly lower rate of CD1P and CD2 or higher events at 3 months follow up (risk difference of -23.1%). Among recorded adverse events, de novo postoperative ejaculatory dysfunction was notably lower in Aquablation (risk difference of -21.9%), while the risk of bleeding remained similar after 6 months. The surgical and medical retreatment rate at 6 months was also lower in Aquablation (risk difference of -14.4%).
Conclusions: In the 50-80 mL prostate volume subgroup, Aquablation yields superior long-term symptom relief and lower complication rates than standard transurethral resection, with notably lower rates of ejaculatory dysfunction. This further supports the adoption of Aquablation for men with medium-sized prostates.

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