REVIEW QUESTION

Does aquablation of the prostate improve lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH)?

TYPE OF REVIEW

A systematic review of one randomized controlled trial (RCT) for a total of 184 participants.

RELEVANCE FOR NURSING

BPH causes prostatic enlargement, subsequently compressing the urethra and causing urinary obstruction. Men may experience bothersome lower urinary tract symptoms as a result, which can negatively affect quality of life (QOL), thus requiring intervention. Initial treatment options for BPH include conservative management (watchful waiting and lifestyle modification) and medications ([alpha] blockers and 5[alpha]-reductase inhibitors). However, if patients don't respond to medical treatment, surgical options may be considered.

Clinical guidelines recommend monopolar or bipolar transurethral resection of the prostate (TURP) as the first-line surgical approach. However, TURP can cause bleeding, urinary tract infections, bladder neck contracture, erectile dysfunction, and retrograde ejaculation. To avoid these, new alternatives-such as aquablation-are being used. Aquablation is a minimally invasive water ablation therapy that combines image guidance and robotics to remove benign prostatic tissue. It is unclear, however, if aquablation improves outcomes with fewer complications than surgical approaches.

CHARACTERISTICS OF THE EVIDENCE

The aim of this review was to assess the effectiveness of aquablation in treating lower urinary tract symptoms in men with BPH. One RCT with a total of 184 participants was included. Participants were men over age 40 (mean age, 65.9 years) who were diagnosed with BPH; aquablation was compared with TURP for up to 12 months after the procedure. Primary outcomes were urological symptom scores, QOL, and major adverse events. Secondary outcomes included retreatment, erectile function, and ejaculatory function.

The authors found that aquablation has similar results to TURP in urological symptom scores and may improve QOL. Little to no difference in risk of adverse events, similar rates of retreatment and erectile and ejaculatory dysfunction, and possibly a small benefit in ejaculatory function for sexually active men were also noted, but very-low-certainty evidence supported each of these findings. Similarly, limited evidence that aquablation may improve urological symptom scores in men with a prostate volume of 50 mL or higher should be viewed with caution.

BEST PRACTICE RECOMMENDATIONS

The authors conclude that the effects of aquablation on urological symptom scores and QOL are probably similar to those of TURP. They were unable to measure adverse events because of concerns over imprecision and selective reporting bias. Evidence was judged to be moderate to very low certainty, depending on the outcome, although 12 months is a short follow-up period. The present evidence does not support the use of aquablation over other treatments in men with lower urinary tract symptoms due to BPH.

RESEARCH RECOMMENDATIONS

Future studies of men with lower urinary tract symptoms due to BPH should compare aquablation with other treatments, such as laser enucleation techniques, prostatic urethral lift, and robotic-assisted simple prostatectomy, in which there is increasing interest. Longer-term data and well-designed prospective observational studies with at least 12 months' follow-up are needed.

SOURCE DOCUMENT

Hwang EC, et al Aquablation of the prostate for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2019;2:CD013143.