University of Auckland, Bay of Plenty Clinical Campus, Tauranga
Introduction:
Introduction: To compare five-year safety and efficacy outcomes after Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) related to benign prostate hyperplasia (BPH).
Methods:
Methods: 181 patients with BPH were assigned at random (2:1 ratio) to either Aquablation or TURP. Patients and follow-up assessors at each site were blinded to treatment. Assessments included International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function (IIEF) and uroflow (Qmax).
Results:
Results: The primary safety endpoint was successfully achieved at 3 months where the Aquablation group had a lower event rate compared to TURP (26% vs. 42%, p=.0149 for superiority). The rate of persistent grade 1 events (all of which were retrograde ejaculation) at month 3 was lower (7% vs. 25%, p=.0004) after Aquablation and the rate of grade 2 and above events was similar across groups (20% for Aquablation vs. 23% for TURP, p=.3038). 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 five years, IPSS scores improved by 15.5 points in the Aquablation group and 13.5 points in TURP (p=.3768, 95% CI for difference -6.4 to 2.5 points). Improvements in maximum flow rate (Qmax) were large in both groups at 10.4 and 9.0 cc/sec for Aquablation and TURP, respectively (p=.9078, 95% CI for difference -4.3 to 7.0). PSA was reduced in both groups; the change in PSA at month 60 did not differ across groups (p=.9460).
Conclusions:
Conclusion: Aquablation data at five years has been shown to be durable and consistent across all years of follow-up and comparable to TURP. Retrograde ejaculation rates were less for Aquablation. *On behalf of WATER study investigators.
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