Urodynamic Outcomes After Aquablation

Pimentel, Marie Adrianne; Yassaie, Omid; Gilling, Peter

doi:10.1016/j.urology.2019.01.020

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…At enrollment, patients had a mean age of 66 ± 7.4 years, Qmax of 8.4 ± 2.8 ml/s with a PVR of 83.3 ± 67.8 ml, reported median IPSS QoL score of 5 (4-5) and a median urinary symptom IPSS of 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Mean baseline PSA was 3.6 ± 2.7 ng/ml, prostate volume 62 ± 19.4 ml and 21.9% of the patients presented a median prostatic lobe at TRUS.…”

Section: Resultsmentioning

confidence: 99%

“…IPSS urinary symptoms scores dropped from a median of 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26) at baseline to 4 (2-6) within 1 month after surgery, and further improved until reaching 3 (2-5) at the 12-month follow-up, with an improvement of -86.36% (Table 3; Fig. 2c).…”

Section: Functional Outcomesmentioning

confidence: 96%

“…Many studies in literature already demonstrated feasibility and efficacy of this technique in terms of functional outcomes for the treatment of LUTS [17][18][19][20][21]; however, no data are available about the morphological reshaping of the prostatic urethra and bladder cavity induced by the surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

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Assessing Micturition, Sexual Function, and Endoscopic Outcomes One Year After Aquablation: A single center prospective study

Amparore,

De Cillis,

Quarà

et al. 2024

Preprint

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Background: Even if functionally effective for benign prostatic hyperplasia (BPH) symptoms relief, the morphological changes in the prostatic urethra and bladder cavity resulting from Aquablation treatment are still unknown. This study aims to assess the feasibility, safety, and efficacy of Aquablation within one-year post-surgery, focusing on functional and endoscopic outcomes. Methods: Prospective enrollment of patients undergoing Aquablation (10/2018–04/2023) included those with baseline International Prostate Symptom Score (IPSS) ≥10, prostate volume <80 mL, and Qmax ≤12 mL/s. Functional outcomes were evaluated at 1, 3, 6, and 12 months using uroflowmetry (Qmax), evaluation of post void residue (PVR), IPSS, Quality of life (QoL)-IPSS, Sexual Health Inventory for Men (SHIM), Male Sexual Health Questionnaire for ejaculatory dysfuncton(MSHQ-EjD) and Incontinence Severity Index (ISI). Cystoscopy at three months assessed ablation quality on a Likert scale (1-poor; 5-excellent). Measurements included cavity length post-treatment (bladder neck to distal prostatic cavity rim) and preserved prostatic tissue length at the apex (distal prostatic cavity rim to the sphincter). Additional evaluations encompassed veru-montanum preservation, presence of residual fluffy tissue or mucous flaps, ureteral orifices and bladder trigone injuries. Results: Out of 109 enrolled patients, one-year follow-up displayed significant improvements in Qmax (+103.08%), PVR (-75.13%), IPSS (-86.36%), and IPSS-QoL (-80.00%). Aquablation had no impact on erectile function and continence, preserving ejaculatory function in 96.3%. Of the 106 patients undergoing the three-month cystoscopy, prostatic urethra patency was satisfactory to perfect in 96.2%, with a median cavity length of 24 ± 8.2 mm. Residual median lobe occurred in 11.3%, without significant impact on micturition outcomes. Positive outcomes included minimal fluffy tissue and mucosal flaps, and well-preserved ureteral meatuses, verumontanum, and bladder trigone. Conclusion: Aquablation effectively alleviates BPH-related LUTS with minimal impact on ejaculation up to one year post-surgery. A three-month post-surgery endoscopic evaluation supports its safety, efficacy, and precise ablation planning.

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Section: Resultsmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 96%

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Assessing Micturition, Sexual Function, and Endoscopic Outcomes One Year After Aquablation: A single center prospective study

Amparore,

De Cillis,

Quarà

et al. 2024

Preprint

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“…At 3 years, the PSA level was reduced significantly in both groups by 0.9 and 1.1 ng/mL [6]. The urodynamic effects, as assessed by pressure–flow studies, were comparable between TURP‐ and aquablation‐treated patients [7]. Urodynamics demonstrated that before the operation 79% in the aquablation group and 95% of patients in the TURP group were obstructed vs 22% in both groups after the operation at 6 months [7].…”

Section: Resultsmentioning

confidence: 99%

“…The urodynamic effects, as assessed by pressure–flow studies, were comparable between TURP‐ and aquablation‐treated patients [7]. Urodynamics demonstrated that before the operation 79% in the aquablation group and 95% of patients in the TURP group were obstructed vs 22% in both groups after the operation at 6 months [7]. The Water II study recruited 101 patients with a mean (range) prostate volume of 107 (80–150) mL; 12‐months follow‐up data are currently available [5].…”

Section: Resultsmentioning

confidence: 99%

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

2020

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Objectives To provide an update on novel minimally invasive lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) treatments in a non‐systematic review. To define potential target populations for the various new minimally invasive treatments. Methods Recent literature, meta‐analyses and guideline recommendations for aquablation (AquaBeam®; PROCEPT BioRobotics, Redwood City, CA, USA), water vapour thermal therapy (Rezūm®; Boston Scientific, Natick, MA, USA), prostate artery embolisation (PAE), prostatic urethral lift (UroLift®; NeoTract‐Teleflex, Pleasanton, CA, USA) and the temporary implantable nitinol device [i‐TIND® (nitinol butterfly‐like stent ); Medi‐Tate Ltd., Or‐Akiva, Israel] were reviewed. Results Procedures that can be performed on an outpatient basis (Rezūm, PAE, UroLift and i‐TIND) are not an alternative for the standard patient requiring BPH surgery. Their effect on urinary flow, post‐void residual urine volume or bladder outlet obstruction is less pronounced than that of transurethral resection of the prostate (TURP). Yet, these options appear to be valuable for those patients unfit for surgery, men who want to avoid medical therapy in general, or those who want to avoid sexual side‐effects associated with medical therapy or standard BPH surgery (e.g. TURP). Aquablation is the first successfully operationalised robotic resection system, especially for patients with prostates >50 g. Nevertheless, long‐term data are necessary for all novel, minimally invasive treatments. Conclusions Better designed clinical trials, a clearer definition of target populations and a more realistic marketing allow a better characterisation of novel minimally invasive therapies for LUTS/BPH. It is hoped that some of these novel devices will stand the test of time, in contrast to the vast majority of their predecessors.

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Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI‐RS 2023

Tarcan,

Hashim,

Malde

et al. 2024

Neurourology and Urodynamics

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AimsLower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome.MethodsA think tank of ICI‐RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS.ResultsOur think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity.ConclusionFuture research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.

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Urodynamic Outcomes After Aquablation

Cited by 13 publications

References 18 publications

Assessing Micturition, Sexual Function, and Endoscopic Outcomes One Year After Aquablation: A single center prospective study

Assessing Micturition, Sexual Function, and Endoscopic Outcomes One Year After Aquablation: A single center prospective study

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI‐RS 2023

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