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Two-year outcomes after aquablation compared to TURP: Efficacy and ejaculatory improvements sustained

  • Peter 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,
  • Ronald P. Kaufman Jr. 10,
  • Andrew Trainer 11,
  • Andrew Arther 11,
  • Gopal Badlani 12,
  • Mark Plante 13,
  • Mihir Desai 14,
  • Leo Doumanian 14,
  • Alexis E. Te 15,
  • Mark DeGuenther 16,
  • Claus Roehrborn 17
1 Tauranga Urology Research, Tauranga, New Zealand 2 Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, UK 3 San Diego Clinical Trials, San Diego, USA 4 Royal Melbourne Hospital, Melbourne, Australia 5 Houston Metro Urology, Houston, USA 6 Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK 7 Virginia Urology, Richmond, USA 8 Princess of Wales Hospital, Bridgend, UK 9 Urology Associates, P.C.Englewood, USA 10 Albany Medical College, Albany, USA 11 Adult Pediatric Urology & Urogynecology, P.C.Omaha, USA 12 Wake Forest School of Medicine, Winston-Salem, USA 13 University of Vermont Medical Center, Burlington, USA 14 Institute of Urology, University of Southern California, Los Angeles, USA 15 Weill Cornell Medical College, New York, USA 16 Urology Centers of Alabama, Birmingham, USA 17 Department of Urology, UT Southwestern Medical Center, University of Texas Southwestern, Dallas, USA


To compare 2-year safety and efficacy outcomes after Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostate hyperplasia (BPH).


One hundred eighty-one patients with BPH were assigned at random (2:1 ratio) to either Aquablation or TURP. Patients and follow-up assessors were blinded to treatment. Assessments included the International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function and uroflow. The focus of analysis was 2-year outcomes.


At 2 years, IPSS scores improved by 14.7 points in the Aquablation group and 14.9 points in TURP (p = .8304, 95% CI for difference − 2.1 to 2.6 points). Two-year improvements in maximum flow rate (Qmax) were large in both groups at 11.2 and 8.6 cc/s for Aquablation and TURP, respectively (p = 0.1880, 95% CI for difference − 1.3 to 6.4). Sexual function as assessed by MSHQ was stable in the Aquablation group and decreased slightly in the TURP group. At 2 years, PSA was reduced significantly in both groups by 0.7 and 1.2 points, respectively; the reduction was similar across groups (p = 0.1816). Surgical retreatment rates after 12 months for Aquablation were 1.7% and 0% for TURP. Over 2 years, surgical BPH retreatment rates were 4.3% and 1.5% (p = 0.4219), respectively.


Two-year efficacy outcomes after TURP and Aquablation were similar, and the rate of surgical retreatment was low and similar to TURP.

Trial Registration

ClinicalTrials.gov no. NCT02505919.


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