“Aquabeam® System” for benign prostatic hyperplasia and LUTS: birth of a new era. A systematic review

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“Aquabeam® System” for benign prostatic hyperplasia and LUTS: birth of a new era. A systematic review of functional and sexual outcome and adverse events of the technique

Reale Giulio● Cimino Sebastiano● Bruno Giorgio● Palmieri Fabiano● Giardina Raimondo● Russo Giorgio Ivan● Grimaldi Enrico● Voce Salvatore● Morgia Giuseppe





Abstract

Purpose
Aim of this systematic review is to evaluate functional outcomes (Qmax, QoL, IPSS, PVR), sexual outcome (erectile dysfunction and anejaculation rate), and adverse events evaluated according to the Clavien–Dindo classification.

Methods
The bibliographic search with the included terms (prostate, benign prostatic hyperplasia, benign prostatic enlargement, lower urinary tract symptoms, water jet dissection, aquablation, Aquabeam®) produced a literature of 32 articles altogether. After removing papers of not interest or articles which the outcomes could not be deduced, nine studies were examined for a total of 664 patients screened.

Results
The functional outcomes, evaluated after water jet dissection, have shown improvement with respect to the baseline in all the selected articles. In the comparison papers with the TURP, the Aquablation has been statistically not inferior regarding functional outcomes. The sexual outcomes have highlighted a better ejaculation rate for water jet dissection than TURP. Regarding the adverse events, water jet dissection documented low rates of adverse events and, in comparison studies, were not statistically superior than TURP.

Conclusions
In our systematic review, the Aquabeam® System for the treatment of LUTS/BPH has proven to be a safe technique that provides functional outcomes comparable to TURP.
About sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, other multicenter randomized trials with larger cohorts and longer follow-up are still needed.










Conclusion

To the best of our knowledge, ours is the first systematic review performed on the technique of aquablation. It is an innovative and fascinating surgery that provides functional outcomes (increase Qmax and QoL, reduction of IPSS and PVR) comparable to TURP. It proved to be a safe technique, with a rate of adverse events similar to TURP. From the point of view of sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, multicenter randomized trials with larger cohorts and longer follow-up are still needed. Further comparison studies are necessary, both with the TURP and with the other techniques used today as laser therapy.
 

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