Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes

Peter J. Gilling ¹,
Neil Barber ²,
Mohamed Bidair ³,
Paul Anderson ⁴,
Mark Sutton ⁵,
Tev Aho ⁶,
Eugene Kramolowsky ⁷,
Andrew Thomas ⁸,
Barrett Cowan ⁹,
Claus Roehrborn ¹⁰

¹ Tauranga Urology Research, Tauranga, New Zealand ² Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, UK ³ San Diego Clinical Trials, San Diego, CA ⁴ Royal Melbourne Hospital, Melbourne, Australia ⁵ Houston Metro Urology, Houston, TX ⁶ Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK ⁷ Virginia Urology, Richmond, VA ⁸ Princess of Wales Hospital, Bridgend, Wales, UK ⁹ Urology Associates, P.C., Englewood, CO ¹⁰ UT Southwestern Medical Center, Department of Urology, University of Texas Southwestern, Dallas, TX

Abstract

DOI: https://doi.org/10.1016/j.urology.2018.12.002

https://www.goldjournal.net/article/S0090-4295(18)31308-6/abstract

Objective

To report 1-year safety and efficacy outcomes after either Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH)

Methods
This double-blinded, multicenter prospective randomized controlled trial assigned 181 patients with BPH-related moderate-to-severe lower urinary tract symptoms to either electrocautery-based prostate resection (TURP) or Aquablation. Efficacy endpoints included reduction in International Prostate Symptom Score and improvement in uroflow parameters. The primary safety endpoint was the occurrence of Clavien-Dindo persistent grade 1 or grade 2 or higher complications.

Results
BPH symptom score improvements were similar across groups with 12-month reduction of 15.1 points after TURP or Aquablation. In both groups, mean maximum urinary flow rates increased markedly postoperatively, with mean improvements of 10.3 cc/s for Aquablation versus 10.6 cc/s for TURP (P = .8632). At 1 year, Prostate-specific antigen (PSA) was reduced significantly (P < .01) in both groups by 1 point; the reduction was similar across groups (P = .9125). Surgical retreatment for BPH rates for TURP were 1.5% and Aquablation 2.6% within 1 year from the study procedure (P = not significant (NS)). The rate of late complications was low, with no procedure-related adverse events after month 6.

Conclusion
The 1-year outcomes after TURP and Aquablation were similar and the rate of late procedure-related complications was low. (ClinicalTrials.gov number, NCT02505919).