Aquablation for Dual Burden Disease - BPH and Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Single-Center Prospective Pilot Study

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for approximately 90–95% of prostatitis cases and is defined by pelvic pain or discomfort persisting for at least three of the preceding six months in the absence of identifiable infection. Despite its high prevalence, management remains challenging, and no standardized treatment approach has been established. In men with concomitant benign prostatic hyperplasia (BPH), bladder outlet obstruction may contribute to symptom persistence or severity. Aquablation, a robot-assisted, waterjet-based therapy used for the treatment of BPH, enables precise, heat-free prostatic tissue removal and may provide symptomatic benefit in this clinical setting. Methods: We performed a prospective pilot study including 20 men aged 45 years or older with diagnoses of both BPH and CP/CPPS who reported moderate to severe pain symptoms (NIH Chronic Prostatitis Symptom Index [NIH-CPSI] ≥ 8). All patients underwent Aquablation between July and December 2024 and were evaluated at 1, 3, and 6 months following the procedure. Primary outcome measures included changes in International Prostate Symptom Score (IPSS) and NIH-CPSI, with assessment across pain, urinary, and quality-of-life (QoL) domains. Results: Significant improvements in both IPSS and NIH-CPSI scores were observed by 3 months postoperatively (p < 0.001), with further modest and sustained improvements noted at 6 months. The greatest symptom reductions were seen in pain and quality-of-life domains. No major adverse events occurred during the study period. Conclusions: Aquablation may offer a dual therapeutic benefit in patients with coexisting BPH and CP/CPPS by addressing both lower urinary tract obstruction and chronic pelvic pain. These preliminary results support further investigation of Aquablation as a treatment option for selected patients with refractory CP/CPPS.