WATER II Trial (Aquablation)
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BPH-RELATED VOIDING DYSFUNCTION (R LEE, SECTION EDITOR)
WATER II Trial (Aquablation) Thomas J. De Los Reyes 1 & Naeem Bhojani 2 & Kevin C. Zorn 2 & Dean S. Elterman 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review discusses the role of aquablation therapy for the treatment of benign prostatic hyperplasia in those with prostate volumes between 80 and 150 mL (WATER II trial). Recent Findings Aquablation therapy reduced International Prostate Symptoms Scores, improved urinary flow rate, and preserved ejaculatory function in the majority of sexually active patients. Other advantages include faster operative times and a shorter learning curve. Adverse events were low and predominantly centered around bleeding risk. Summary Aquablation therapy is effective and safe in the surgical management of large prostates thereby offering alternatives to surgeons and patients alike. Keywords BPH . Benign prostatic hyperplasia . Aquablation . Aquabeam . Prostate
Introduction Prostate size is a key factor in determining surgical options for men with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPH). In those with prostate sizes greater than 80 mL, treatment options commonly offered include simple prostatectomy (open, laparoscopic/robotic), laser enucleation with holmium or thulium lasers (HoLEP or ThuLEP), or greenlight laser photoselective vaporization (PVP). Each treatment modality has its procedural merits and disadvantages, ranging from risk of bleeding, hospital stay, learning curve, and operative time [1–4]. Aquablation therapy uses a thermic water jet technology to resect prostate tissue. The surgeon plans the resection path using ultrasonography after which prostate resection is then executed robotically. The original WATER study, which was a prospective, double-blind multicentre trial established that aquablation therapy was non-inferior to transurethral resection
This article is part of the Topical Collection on BPH-Related Voiding Dysfunction * Dean S. Elterman [email protected] 1
Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
2
Division of Urology, University of Montreal Hospital Centre, University of Montreal, Montreal, Quebec, Canada
of the prostate (TURP) in efficacy as measured by improvement in the international prostate symptom score (IPSS) in prostate sizes of 30–80 mL [5•]. This review will focus on the results of the WATER II trial where patients suffering from LUTS secondary to BPH and a prostate volume of 80–150 mL underwent aquablation therapy.
Trial and Procedural Design The WATER II trial was a prospective, multicentre trial of aquablation treatment in men aged 45–80 years with LUTS secondary to BPH and a prostate size of 80–150 mL measured by transrectal ultrasound (TRUS) [6••]. The complete inclusion and exclusion criteria can be found in the original trial manuscript [6••]. Notably, the inclusion criteria include patients who are in urinary retention a
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