The waterjet ablation (Aquabeam®) for treatment of symptomatic benign prostatichyperplasia: 3-years functional outcomes from a large Italian series (>200 cases)

Background Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) significantly affect the quality of life in men. Traditional surgical treatments offer symptom relief but may contribute to sexual dysfunction. Waterjet ablation, or Aquablation, is a minimally invasive technique, alternative to standard Holmium-laser enucleation of prostate (HoLEP), that uses high-pressure water to ablate prostatic tissue, offering both functional and sexual advantages. This study aimed to evaluate the three-year functional outcomes of Aquabeam® waterjet ablation for the treatment of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). We focused on measuring changes in urinary symptoms, quality of life, continence, and ejaculatory function, along with the incidence of complications. Methods We conducted a retrospective analysis from a prospectively maintained database of 218 consecutive BPH patients treated with Aquabeam® waterjet ablation. The procedures were performed between January 2019 and January 2022 across three referral centers for BPH management. Functional outcomes were evaluated pre- and post-operatively and included International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine (PVR), continence status, sexual function, and ejaculatory function. The median follow-up was 3 years. Results The median age of patients at surgery was 61 years (IQR: 57–66), with median PSA levels of 2.52 ng/mL (IQR: 0.4–21.6) and a median prostate volume of 55 mL (IQR: 40–73). The median operative time was 56 minutes (IQR: 20–168), with a median catheterization time of 48 hours (IQR: 24–480) and a hospital stay of 48 hours (IQR: 24–600). At 3-year follow-up, patients experienced significant symptom relief, with a median IPSS score of 5 (IQR: 3–21) and a Qmax of 18 mL/s (IQR: 9–26). These results were significantly better than baseline scores, observed as early as three months post-procedure, and remained stable throughout the follow-up period. The continence rate was 100%, and the ejaculation preservation rate was 87%, with a positive trend over time. Complications were classified according to the Clavien-Dindo system: 8.3% of patients experienced Grade 1 complications (18 patients), 11.9% had Grade 2 (26 patients), and only 0.5% encountered Grade 3 complications. All complications were temporary and resolved completely without any long-term effects. Conclusions The Aquabeam® waterjet ablation procedure was safe, effective, and reproducible, offering clinically meaningful improvement in LUTS and quality of life for BPH patients. Its ability to preserve ejaculation in a high percentage of patients underscores its advantage over traditional methods. These medium-term outcomes are promising, although further research into long-term durability is necessary to confirm the sustained benefits of the procedure.