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Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial
Author(s) -
Plante Mark,
Gilling Peter,
Barber Neil,
Bidair Mohamed,
Anderson Paul,
Sutton Mark,
Aho Tev,
Kramolowsky Eugene,
Thomas Andrew,
Cowan Barrett,
Kaufman Ronald P.,
Trainer Andrew,
Arther Andrew,
Badlani Gopal,
Desai Mihir,
Doumanian Leo,
Te Alexis E.,
DeGuenther Mark,
Roehrborn Claus
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14426
Subject(s) - medicine , clinical endpoint , urology , subgroup analysis , prostate , international prostate symptom score , randomized controlled trial , post hoc analysis , placebo , transurethral resection of the prostate , lower urinary tract symptoms , surgery , confidence interval , alternative medicine , pathology , cancer
Objective To test the hypothesis that benign prostatic hyperplasia ( BPH ) robotic surgery with aquablation would have a more pronounced benefit in certain patient subgroups, such as men with more challenging anatomies (e.g. large prostates, large middle lobes) and men with moderate BPH . Methods We conducted prespecified and post hoc exploratory subgroup analyses from a double‐blind, multicentre prospective randomized controlled trial that compared transurethral resection of the prostate ( TURP ) using either standard electrocautery vs surgery using robotic waterjet (aquablation) to determine whether certain baseline factors predicted more marked responses after aquablation as compared with TURP . The primary efficacy endpoint was reduction in International Prostate Symptom Score ( IPSS ) at 6 months. The primary safety endpoint was the occurrence of Clavien–Dindo persistent grade 1 or grade ≥2 surgical complications. Results For men with larger prostates (50–80 g), the mean IPSS reduction was four points greater after aquablation than after TURP ( P = 0.001), a larger difference than the overall result (1.8 points; P = 0.135). Similarly, the primary safety endpoint difference (20% vs 46% [26% difference]; P = 0.008) was greater for men with large prostate compared with the overall result (26% vs 42% [16% difference]; P = 0.015). Postoperative anejaculation was also less common after aquablation compared with TURP in sexually active men with large prostates (2% vs 41%; P < 0.001) vs the overall results (10% vs 36%; P < 0.001). Exploratory analysis showed larger IPSS changes after aquablation in men with enlarged middle lobes, men with severe middle lobe obstruction, men with a low baseline maximum urinary flow rate, and men with elevated (>100) post‐void residual urine volume. Conclusions In men with moderate‐to‐severe lower urinary tract symptoms attributable to BPH and larger, more complex prostates, aquablation was associated with both superior symptom score improvements and a superior safety profile, with a significantly lower rate of postoperative anejaculation. The standardized, robotically executed, surgical approach with aquablation may overcome the increased outcome variability in more complex anatomy, resulting in superior symptom score reduction.