What is the success rate of Aquablation (Aquablation therapy) for treating Benign Prostatic Hyperplasia (BPH)?

Success Rate of Aquablation for Benign Prostatic Hyperplasia (BPH)

Aquablation therapy demonstrates a success rate comparable to TURP with 50% improvement in International Prostate Symptom Score (IPSS) at 36 months, while offering fewer complications (26% vs 42%) and significantly lower rates of ejaculatory dysfunction (10% vs 36%) compared to TURP. 1, 2

Efficacy Outcomes

• Aquablation provides noninferior functional outcomes compared to TURP in patients with LUTS and prostate volumes between 30-80 ml during mid-term follow-up 1
• IPSS improvements are substantial and durable:
  • Mean IPSS reduction of 16.3 points at 3 years (from 23.2 at baseline to 6.5) 3
  • Similar symptom reduction across different prostate sizes (14.4 point reduction for 30-80cc prostates vs 16.3 point reduction for 80-150cc prostates at 36 months) 4
• Maximum urinary flow rate (Qmax) shows significant improvement:
  • Increases from baseline 8.7 ml/s to 18.5 ml/s at 3 years 3
  • Comparable to TURP improvements (10.3 ml/s for Aquablation vs 10.6 ml/s for TURP) 5
• Quality of life scores improve by 49% from baseline at 3 years 2

Safety Profile and Complications

• Aquablation demonstrates fewer complications than TURP (26% vs 42%) 1
• Blood loss considerations:
  • Significant hemoglobin drop (2.06 g/dl) has been reported 1
  • However, transfusion rates remain low 1, 2
• Sexual function preservation:
  • Ejaculatory dysfunction rates are significantly lower with Aquablation compared to TURP (10% vs 36%) 1
  • Among sexually active men, fewer patients report worsening sexual function with Aquablation compared to TURP (33% vs 56%) 2

Retreatment Rates

• Retreatment rates at 3 years are low but slightly higher than TURP:
  • 4.3% for Aquablation vs 1.5% for TURP 1
  • 3% surgical retreatment rate at 3 years in large prostates (80-150cc) 3
  • 96-97% of patients remain free from surgical retreatment at 3 years across different prostate sizes 4
• Medication freedom is high, with 94-98% of patients remaining BPH medication-free at 3 years 4

Effectiveness by Prostate Size

• Aquablation maintains similar efficacy across different prostate sizes:
  • Effective for small-to-moderate sized prostates (30-80cc) 6, 4
  • Equally effective for large prostates (80-150cc) 3, 6, 4
  • Can successfully treat prostates with intravesical median lobes 7

Limitations and Considerations

• The European Association of Urology does not provide a specific recommendation strength for Aquablation in their 2023 guidelines 1
• The American Urological Association gives Aquablation a Conditional Recommendation with Evidence Level Grade C 2
• There are still some concerns about the best methods for achieving post-treatment hemostasis 1
• Long-term data beyond 3 years is currently limited 2

Clinical Implications

• Aquablation represents a viable alternative to TURP for BPH treatment, particularly for patients concerned about sexual function preservation 1, 2
• The procedure is effective across a wide range of prostate sizes, including large prostates that traditionally required more invasive procedures 3, 6, 4
• The balance of efficacy (similar to TURP) with fewer complications makes it an attractive option for appropriate candidates 1, 2