Naeem Bhojani, MD, discusses WATER III data on Aquablation vs enucleation for BPH

Three-month data from the WATER III trial (NCT04801381) were recently shared during the 40th Annual European Association of Urology Congress in Madrid, Spain, showing that Aquablation offered similar short-term symptom improvement to transurethral laser enucleation of large prostates (LEP).¹

The data also showed that patients who underwent Aquablation demonstrated lower rates of ejaculatory dysfunction and stress incontinence compared with those who underwent LEP. In the following interview, Naeem Bhojani, MD, FRCSC, provides an overview of the background and key findings from the study.

Bhojani is a professor of urology at the University of Montreal, Quebec, Canada.

Overall, Aquablation demonstrated non-inferiority to LEP regarding the study’s primary end point of mean change in International Prostate Symptom Score (IPSS). Specifically, the change in IPSS from baseline to 3 months was 12.9 in the Aquablation arm vs 13.1 in the LEP arm (mean delta, 0.86; 95% CI, -1.6 to 3.2; P = .745).

Patients in the Aquablation arm also demonstrated lower rates of ejaculatory dysfunction (P < .0001) and urinary incontinence (P = .0690) following surgery.

However, urinary flow rate improvement from baseline to 3 months was greater in the LEP arm (P < .0001). Patients in the LEP arm also saw a greater reduction in post-void residual (P = .2956).

Bleeding risk was comparable between both arms.

REFERENCE

1. Ritter M, Stein J, Barber N, et al. WATER III: Aquablation vs. Transurethral laser enucleation of large prostates (80-180ml) in benign prostatic hyperplasia. Presented at 40th Annual European Association of Urology Congress. Madrid, Spain. March 21-24, 2025. Abstract GC4