Randomized Controlled Trial of Aquablation vs. Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-Year Outcomes.

OBJECTIVE: To report 1-year safety and efficacy outcomes after either Aquablation or TURP for the treatment of lower urinary tract symptoms related to BPH.

METHODS: This double-blinded, multicenter prospective randomized controlled trial assigned 181 patients with BPH-related moderate-to-severe lower urinary tract symptoms to either electrocautery-based prostate resection (TURP) or Aquablation. Efficacy endpoints included reduction in International Prostate Symptom Score and improvement in uroflow parameters. The primary safety endpoint was the occurrence of Clavien-Dindo persistent grade 1 or Grade 2 or higher complications.

RESULTS: BPH symptom score improvements were similar across groups with 12-month reduction of 15.1 points after TURP or Aquablation. In both groups, mean maximum urinary flow rates increased markedly postoperatively, with mean improvements of 10.3 cc/sec for Aquablation vs. 10.6 cc/sec for TURP (p=.8632). At 1 year, PSA was reduced significantly (p<.01) in both groups by 1 point; the reduction was similar across groups (p=.9125). Surgical retreatment for BPH rates for TURP were 1.5% and Aquablation 2.6% within 1 year from the study procedure (p=NS). The rate of late complications was low, with no procedure-related adverse events after month 6.

CONCLUSIONS: One-year outcomes after TURP and Aquablation were similar and the rate of late procedure-related complications was low. (ClinicalTrials.gov number, NCT02505919).