Urologists at Hackensack University Medical Center (HUMC) in Northern New Jersey are now offering Aquablation therapy for men with benign prostatic hyperplasia (BPH) that cannot be effectively treated with medication.1
"Aquablation therapy is as effective as…other minimally invasive treatments [for these men] but with fewer side effects, including only a 10% to 15% risk of retrograde ejaculation," Ravi Munver, MD, vice chair of Urology and division director of Minimally Invasive and Robotic Urologic Surgery at HUMC, stated in a press release.
"Aquablation is performed using a robotic system with ultrasound guidance. As a result, the procedure can be completed rapidly and with a higher level of precision that is reproducible from surgeon to surgeon. The advantage of real-time ultrasound imaging is that a surgeon can see where the prostate tissue ends, which allows removal of more of the excess tissue. Aquablation therapy is the only heat-free and image-guided waterjet ablation approach that is available to treat BPH," added Munver.
Clinical support for Aquablation
Five-year results from the pivotal WATER trial published earlier this year in the Canadian Journal of Urology2 demonstrated strong efficacy and safety with Aquablation vs transurethral resection of the prostate (TURP) for the treatment of men with lower urinary tract symptoms (LUTS) related to BPH.
International Prostate Symptom Score (IPSS) data at 5 years showed that among patients receiving Aquablation, IPSS improved by 15.1 points compared with 13.2 points among patients receiving TURP (P = .2764). Of note, across all follow-up visits for patients with larger prostates (>50 mL), the reduction in IPSS was 3.5 points higher with Aquablation vs TURP (P = .0123). Peak urinary flow rate compared to baseline improved by 125% vs 89% in the Aquablation and TURP groups, respectively. The rate of retreatment (needing surgical intervention or BPH medication) for patients receiving Aquablation was about 1% per year. Compared to TURP, this represented a 51% reduction.
The prospective, randomized, double-blind, multicenter WATER trial (NCT02505919) compared the safety and efficacy of Aquablation and TURP as surgical treatments for BPH-related LUTS in men aged 45 to 80 years old who had a prostate size of 30 mL to 80 mL. Patient characteristics at baseline were well balanced between the study arms. Patients were randomized in a 2:1 ratio to Aquablation or TURP. The 5-year analysis included 116 patients randomized to Aquablation and 65 patients randomized to TURP.
It was previously determined that the study met its primary end point with Aquablation leading to a 16.9 mean IPSS decrease from baseline compared with a mean decrease of 15.1 points with TURP (P <.0001 for noninferiority; P = .1346 for superiority).
Regarding safety, the event rate at 3 months was 26% with Aquablation vs 42% with TURP (P = .0149). The rate of procedure-related ejaculatory dysfunction was 7% vs 25%, respectively (P = .0004).
The specific Aquablation tool being used at HUMC is the AquaBeam Robotic System, which is used with guidance from real-time imaging.
"Depending on the size of the prostate, the resection time may take as little as 5 minutes," Michael D. Esposito, MD, a urologist at HUMC stated in the press release. "Aquablation achieves years of prostate relief, and we're thrilled to offer this new option to our patients."
1. Hackensack University Medical Center Becomes First in North Jersey to Offer Aquablation® Therapy to Treat Enlarged Prostates. Published online August 29, 2022. Accessed August 30, 2022. https://prn.to/3R3Kdyt
2. Gilling PJ, Barber N, Bidair M, et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022;29(1):10960-10968.