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Is Aquablation experimental?

Aquablation is still considered experimental, however. More research is needed before it can be recommended as a treatment for enlarged prostate.

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Men with benign prostatic hypertrophy (BPH) - an enlarged prostate - may eventually have a new treatment option. Scientists are studying a method called “aquablation,” which uses a waterjet to remove excess prostate tissue. Recent clinical trials that compare the method with the “gold standard” transurethral resection of the prostate (TURP) have had encouraging results, according to research presented at the Sexual Medicine Society of North America’s Fall Scientific Meeting, held in November 2017. Enlarged prostate is a common condition, especially in older men, and it often leads to urinary problems. That’s because part of the urethra, the tube that carries urine out of the body, is surrounded by prostate tissue. Because the prostate tissue grows inward, it can squeeze the urethra, making it difficult for a man to urinate. During a TURP procedure, a surgeon trims excess prostate tissue with an instrument called a resectoscope. Aquablation trims tissue too, but with a robotically-controlled high-pressure waterjet. Surgeons use ultrasound images on a computer monitor to map progress and make adjustments. About two-thirds of men have some degree of sexual dysfunction after TURP, especially problems with ejaculation. In the trial, scientists wanted to know whether aquablation would have better sexual outcomes. The study involved 181 men between the ages of 45 and 80. Both procedures appeared to have similar results for urinary symptoms. For sexual symptoms, men treated with aquablation tended to have better ejaculatory function than those who underwent TURP. Aquablation is still considered experimental, however. More research is needed before it can be recommended as a treatment for enlarged prostate.

“Transurethral resection of the prostate (TURP)”

(August 9, 2017)

https://www.mayoclinic.org/tests-procedures/turp/home/ovc-20211753

Medscape

Helwick, Caroline

“'Aquablation' via Robot-Controlled Waterjet Treats BPH”

(November 1, 2017)

https://www.medscape.com/viewarticle/887925#vp_1

Procept Biotics

No title - Video describing AquaBeam aquablation treatment that was used in the trial.

http://www.procept-biorobotics.com/technology.php

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What is the gold standard surgical treatment for BPH?

TURP is considered as the accepted standard of surgical therapy for the management of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH).

The role of transurethral prostate resection (TURP) in patients with benign prostate obstruction (BPO) was re-examined during Plenary Session 3 against the backdrop of new technologies such as the use of laser ablation techniques. TURP is considered as the accepted standard of surgical therapy for the management of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH). But as a major operative procedure, it has been associated with significant perioperative morbidity. In recent years, TURP has been somehow pushed to the sidelines amid the popularity of modern laser ablation techniques. In his state-of-the-art lecture, Prof. Michael Marberger (AT) posed the query on whether TURP retains its role as a standard tool in managing prostate obstruction. “We have today in the market a range of laser devices, perhaps as many as 20 different kinds. Is there a place for TURP or do we consign it to the museum?,” Marberger said, posing the query whether TURP nowadays is still competitive. He mentioned the various issues associated with TURP such as post-operative retention, blood transfusion and mortality, among others. “TURP has low morbidity and is continuously being improved,” Marberger said noting that the procedure provides an effective and durable solution. Moreover, he said that for TURP to be replaced as a ‘gold’ standard, an alternative has to be “…non-inferior to TURP in results at less morbidity.” “The alternative also has to be technically simple with standardized technique or technology (that is cost-effective and equipment that is readily available),” he added. In his closing remarks, Marberger said: “TURP is not a ‘gold standard’ for treating BPO as it has some problems (like bleeding), but it still is the ‘reference standard’ to be met by all alternative treatment options.”

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