We compared the safety and efficacy of Aquablation and transurethral prostate resection for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. In a double-blind, multicenter, prospective, randomized, controlled trial 181 patients with moderate to severe lower urinary tract symptoms related to benign prostatic hyperplasia underwent transurethral prostate resection or Aquablation. The primary efficacy end point was the reduction in International Prostate Symptom Score at 6 months. The primary safety end point was the development of Clavien-Dindo persistent grade 1, or 2 or higher operative complications. Mean total operative time was similar for Aquablation and transurethral prostate resection (33 vs 36 minutes, p = 0.2752) but resection time was lower for Aquablation (4 vs 27 minutes, p <0.0001). At month 6 patients treated with Aquablation and transurethral prostate resection experienced large I-PSS improvements. The prespecified study noninferiority hypothesis was satisfied (p <0.0001). Of the patients who underwent Aquablation and transurethral prostate resection 26% and 42%, respectively, experienced a primary safety end point, which met the study primary noninferiority safety hypothesis and subsequently demonstrated superiority (p = 0.0149). Among sexually active men the rate of anejaculation was lower in those treated with Aquablation (10% vs 36%, p = 0.0003). Surgical prostate resection using Aquablation showed noninferior symptom relief compared to transurethral prostate resection but with a lower risk of sexual dysfunction. Larger prostates (50 to 80 ml) demonstrated a more pronounced superior safety and efficacy benefit. Longer term followup would help assess the clinical value of Aquablation.

Many technologies have been mooted as equal to transurethral resection of the prostate (TURP) without gaining widespread acceptance because of the lack of randomized trials. The Greenlight laser system (Laserscope, San Jose, Ca.), an 80 W system for photovaporization of the prostate (PVP), was compared with TURP in such a trial. A series of 120 patients was randomized to undergo TURP or PVP after evaluation, which was repeated at 1, 3, 6, and 12 months after treatment. Irrigation use, length of catherization (LOC), length of hospital stay (LOS), postvoiding residual volume, sexual function, blood loss, cost, and operative time also were assessed. To date, 76 patients are evaluable. Both groups showed a significant (P < 0.5) increase in maximum flow rate from baseline. In the TURP group, flow increased from 8.7 to 17.9 mL/sec (149%) and in the PVP group from 8.5 to 20.6 mL/sec (167%). The International Prostate Symptom Score decreased from 25.4 to 12.4(50.23%) in the TURP group and from 25.7 to 12.0 (49.83%) in the PVP group. Postvoiding residual volumes also showed significant decreases. Similar trends were seen in relation to bother and quality of life scores. There was no difference in sexual function as measured by a questionnaire. The LOC was significantly less in the PVP group (P < 0.001), the mean being 12.2 hours (range 0-24 hours) versus 44.5 hours for TURP (range 6-192 hours). A similar situation was seen in relation to LOS (P < 0.0001), with the mean of the PVP group being 1.08 days (range 1-2 days) and the mean for the TURP group being 3.4 days (range 3-9 days). Adverse events were less frequent in the PVP group, and the costs were 22% less. This trial demonstrates that PVP is effective compared with TURP, producing equivalent improvements in flow rates and IPSS with markedly reduced LOS, LOC, and adverse events. Long-term follow- up is being undertaken to assess the durability of these results.

The BJC is owned by Cancer Research UK, a charity dedicated to understanding the causes, prevention and treatment of cancer and to making sure that the best new treatments reach patients in the clinic as quickly as possible. The journal reflects these aims. It was founded more than fifty years ago and, from the start, its far-sighted mission was to encourage communication of the very best cancer research from laboratories and clinics in all countries. The breadth of its coverage, its editorial independence and it consistent high standards, have made BJC one of the world's premier general cancer journals. Its increasing popularity is reflected by a steadily rising impact factor.

We sought to establish the safety and effectiveness of aquablation, a novel, image guided, robotic assisted, water jet tissue ablation technology, for the treatment of benign prostatic hyperplasia. We performed a prospective, single arm, multicenter trial at a total of 3 centers in Australia and New Zealand with 1-year followup. Participants were men 50 to 80 years old with moderate to severe lower urinary tract symptoms as determined by urodynamics. All patients underwent aquablation under image guidance. Primary end points included procedural and perioperative safety. The main clinical end point was the change from baseline in I-PSS (International Prostate Symptom Score). Other secondary end points included uroflow measures, prostate volume on transrectal ultrasound and detrusor pressure. Detrusor pressure at maximum flow was only measured at 6 months. A total of 21 men underwent aquablation at a mean age of 69.7 years (range 62 to 78). Prostate volume was 57.2 ml (range 30 to 102). Procedural duration averaged 38 minutes with a mean aquablation treatment time of 5 minutes. All but 1 subject were catheterized for 1 day only and 19 of 21 were discharged home the day after the procedure. Detrusor pressure at maximum flow decreased from 65 cm H2O at baseline to 39 cm H2O at 6 months (p <0.0027). Prostate volume decreased from 57 ml at baseline to 35 ml (p <0.0001). Mean I-PSS score improved from 23.0 at baseline to 6.8 at 12 months (p <0.0001) and maximum urinary flow increased from 8.7 to 18.3 ml per second (p <0.0001). There were no important perioperative adverse events. No urinary incontinence developed and sexual function was preserved postoperatively. This phase II study provides early evidence to support the safety and effectiveness of aquablation for symptomatic benign prostatic hyperplasia.

To compare 2-year safety and efficacy outcomes after Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostate hyperplasia (BPH).