Waterjet fares better vs. TURP in large prostates

San Francisco-Men with large prostates experience more relief from BPH with treatment by Aquablation therapy (using the AquaBeam System) than with transurethral resection of the prostate (TURP), researchers say.

“Safety favors Aquablation,” Claus G. Roehrborn, MD, professor and chair of urology at the University of Texas Southwestern Medical School in Dallas, told Urology Times. He presented the findings at the AUA annual meeting in San Francisco.

Aquablation, which resects the prostate via robotic, high-velocity waterjet, can remove prostate tissue without applying heat. The procedure includes intraoperative transurethral ultrasound imaging and cystoscopic visualization. The surgeon creates a treatment plan prior to the therapy, then a robot executes the tissue removal while the patient is under general anesthesia.

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A phase III randomized, clinical trial established that Aquablation can treat BPH more effectively than TURP, but researchers wanted to know whether it would work as well in men with particularly large prostates, defined as 50 mL to 80 mL. They analyzed subgroups pre-identified based on prostate volume. Eighty-two men had prostates less than 50 mL and 102 had prostates at least 50 mL.

Among the men with large prostates, the mean baseline International Prostate Symptom Score (IPSS) was 22.2 for those randomly assigned to TURP and 22.9 for those randomly assigned to Aquablation (p=.43). The two groups were similar in age, body mass index, lobes, degree of middle lobe obstruction, and mean prostate volume: 52 mL for TURP versus 54 mL for Aquablation (p=.31).

Next:Shorter mean resection time with waterjetMean operative time was equivalent between the two groups: 32.8 minutes for Aquablation and 35 minutes for TURP (p=.28). But mean resection time was 4 minutes in the Aquablation group versus 28 minutes in the TURP group, a significant difference(p<.0001).

A Clavien-Dindo grade 1 persistent or grade 2 or higher event occurred in the first 3 months in 20% of Aquablation subjects and 46% of TURP subjects (p<.02).

At 180 days, men with a prostate volume >50 mL experienced an improvement in their IPSS scores of 17.4 points with Aquablation, compared to 13.3 points with TURP, which was statistically significant (p=.02).

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Among the other findings:

• Men with a baseline flow rate of <9 mL/sec treated with Aquablation saw their IPSS score improve to 17.9 points, compared to 14.3 points with TURP, which was statistically significant (p=.03).
• Men with a middle lobe present treated with Aquablation attained an IPSS score of 19.9 compared to 11.0 with TURP, which was statistically significant (p=.005).
• Men with both larger prostates and lower flow rates (<9 mL/sec), experienced 7 points greater change in IPSS scores compared to TURP (p<.0001).
• For men with smaller prostates and greater maximum flow rates, the improvement in IPSS with TURP was 4.3 points larger than with Aquablation. However, this difference was not statistically significant (p=.0963).

PROCEPT BioRobotics provided funding for the study. Dr. Roehrborn is an investigator and meeting participant/lecturer for PROCEPT BioRobotics; a consultant/adviser, investigator, and meeting participant/lecturer for NeoTract, Inc.; and an investigator and consultant/adviser for NxThera, Inc. He has several other disclosures related to pharmaceutical companies. His co-author, Peter Gilling, MD, is an investigator and meeting participant/lecturer for PROCEPT BioRobotics.