Aquablation/
AquaBeam
Waterjet Therapy for Benign Prostatic Hyperplasia: Three‐Year Functional and Ejaculatory Outcomes in a Multicenter Real‐World Italian Cohort
Angelo Porreca, Daniele D'Agostino, Davide De Marchi, Marco Giampaoli, Filippo Marino, Gian Maria Busetto, Antonio Amodeo, Paolo Corsi, Francesco Claps, Luca Di Gianfrancesco ABSTRACT
Objective
To evaluate the 3‐year functional outcomes of Aquablation/AquaBeam waterjet therapy for bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), with particular attention to urinary symptoms, quality of life, continence, ejaculatory function, and complications.
Methods
We performed a retrospective analysis of a prospectively maintained multicenter database including 218 consecutive men who underwent Aquablation/AquaBeam for symptomatic BPH between January 2019 and January 2022 at three referral centers. Functional outcomes assessed preoperatively and during follow‐up included International Prostate Symptom Score (IPSS), IPSS quality‐of‐life item (IPSS‐QoL), maximum urinary flow rate (Qmax), post‐void residual urine (PVR), continence, and ejaculatory function. Median follow‐up was 36 months. Ejaculatory preservation was evaluated only in patients with preserved antegrade ejaculation at baseline.
Results
Median age was 61 years (IQR 57–66), median prostate‐specific antigen (PSA) was 2.52 ng/mL (IQR 0.40–21.60), and median prostate volume was 55 mL (IQR 40–73). Median operative time was 56 min, while median catheterization time and length of hospital stay were both 48 h. Functional improvements were evident from the 3‐month follow‐up and remained stable through 36 months. At 36 months, median IPSS improved to 5 and median Qmax to 18 mL/s. Median PSA changed modestly from 2.52 ng/mL at baseline to 2.75 ng/mL at 36 months. No cases of de novo urinary incontinence were observed throughout follow‐up. Among patients with preserved antegrade ejaculation at baseline, 87% maintained antegrade ejaculation at 36 months. Most postoperative complications were minor (Clavien‐Dindo grade I‐II, 20.2%). One grade III rectal injury occurred (0.5%). Median hemoglobin decreased from 15.2 g/dL preoperatively to 14.0 g/dL before hospital discharge, and two patients required blood transfusion. During the 36‐month follow‐up, no surgical retreatment was required, whereas 11 patients (5.0%) received temporary medical retreatment.
Conclusion
In this multicenter real‐world cohort, Aquablation/AquaBeam was safe and effective over 3 years, providing durable improvement in lower urinary tract symptoms and quality of life while preserving continence and antegrade ejaculation in most patients. These findings support Aquablation/AquaBeam as a valuable minimally invasive surgical option for selected men with BPH, particularly those who prioritize preservation of ejaculatory function. Longer‐term and comparative studies are warranted.
Trial Registration
48281