4th Annual Jefferson Urology Symposium: Focus on Urinary Incontinence

© The Canadian Journal of Urology TM : International Supplement, August 2021 Aquablation of the prostate: a review and update Anthony T. Tokarski, MD, 1 Joon Yau Leong, MD, 1 Claus G. Roehrborn, MD, 2 Asaf Shvero, MD, 1,3 Akhil K. Das, MD 1 1 Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA 2 Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA 3 Department of Urology, Sheba Medical Center, Israel. Affiliated with Tel Aviv University, Tel Aviv, Israel TOKARSKI AT, LEONG JY, ROEHRBORN CG, SHVERO A, DAS AK. Aquablation of the prostate: a review and update. Can J Urol 2021;28(Suppl 2): 17-21. Introduction: Historically, transurethral resection of the prostate (TURP) was considered the endoscopic “gold standard” surgical treatment of benign prostatic hyperplasia (BPH). Over the years, several other endoscopic procedures emerged, including the size- independent holmium laser enucleation of the prostate (HoLEP). In an effort to reduce the cost and morbidity associated with traditional endoscopic techniques, novel minimally invasive techniques have been developed, one of which is Aquablation. This review is an update of a previously published review article looking at the most recently published available data on Aquablation. Materials and methods: This review article covers the technical aspects of Aquablation and provides an update on the recently published literature regarding Aquablation compared to TURP and HoLEP. Results: At up to 3 years of follow up, Aquablation performs favorably when compared to TURP in terms of alleviation of lower urinary tract symptoms (LUTS) and preservation of sexual function compared to TURP. Safety profile was similar between Aquablation and TURP. Conclusions: Aquablation is a safe and effective method of treating LUTS associated with BPH. At up to 3 years of follow up, it has shown a durable with efficacy similar to TURP. Key Words: Aquablation, minimally invasive therapy, lower urinary tract symptoms, benign prostatic hyperplasia Address correspondence to Dr. Anthony T. Tokarski, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107 USA Introduction Benign prostatic hyperplasia (BPH) is a common condition affecting approximately 25% of men at the age of 50, with almost 80% of men older than 70 affected. 1 BPHis causedby the unregulatedproliferation of the transitional zone of the prostate, which leads to compression of the prostatic urethra. Physical compression of the urethra causes bladder outlet obstruction (BOO), and leads to the symptoms of BPH, known as lower urinary tract symptoms (LUTS). 2 The gold standard for endoscopic surgical treatment of this conditionhas historicallybeen the transurethral resection of the prostate (TURP), whichwas first developed in the early 1920s. 3 The TURP technique, although effective, haswell establishedmorbidities, suchas TUR-syndrome, infection, bleeding risk, sexual side effects, and others. 4 Innovations in BPH managed have been targeted towards decreasing surgical morbidity and decreasing overall operative time while maintaining successful alleviation of the LUTS associated with BPH. One such technique is the ultrasound guided, robot assisted waterjet that can precisely target and ablate prostatic tissue, known as Aquablation. This technique is performed using the Aquabeam system (PROCEPT Biorobotics, Redwood Shores, CA, USA). This surgical intervention was developed with the aim to 17