Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Lisa Murphy, PA-C, MSPAS
Abstract
Introduction:
Benign Prostatic Hypertrophy (BPH) is a condition affecting adult males causing symptoms including urinary frequency, incontinence, and urinary retention. While first line treatment methods include lifestyle modifications and pharmacologic therapies, many patients elect for surgical procedures for symptomatic relief. In patients with extremely large volume prostates the surgical method most commonly used has been an open prostatectomy, which is associated with both long-term efficacy and more surgical complications than minimally invasive techniques. Therefore, this review analyzes Aquablation (I) for symptom management (O) in patients diagnosed with BPH (P) compared to open prostatectomy (C).
Methods:
A literature search was conducted in November 2018 using PubMed and Google Scholar. Seven studies were included which compared symptomatic relief in those undergoing open prostatectomies and Aquablation interventions. Selected studies included prospective, cohort, and randomized control trials. The overall study design, validity, and results were analyzed and compared.
Results:
In two studies directly evaluating Aquablation, there was a statistically significant change in IPSS for the large volume prostates. In one of these, PVR, QMAX, and QOL were significantly improved, whereas the other study found no improvement. Another study that assessed a minimally invasive technique compatible to aquablation found significant improvement in IPSS and Qmax. The three studies evaluating open prostatectomies found significant improvements in IPSS, PVR, and Qmax, and QOL. All of these studies except one followed up for at least 6 months.
Discussion:
All studies showed some symptomatic improvement after intervention, which is the goal for treatment modalities. However, there were no studies directly comparing Aquablation to open prostatectomies. Some of the aquablation studies did not evaluate all outcome measurements and lacked long-term data. Additionally, many studies were not double blinded, nor randomized control trials.
Conclusion:
Though aquablation demonstrates some symptomatic improvement, not every study had the same results or evaluated all outcome measures. Without a more thorough evaluation of all outcome measures, or direct comparison to open prostatectomy, a change in the gold standard treatment cannot be recommended. While this analysis did not look at safety measures, minimally invasive techniques tend to be safer than surgery. However, this statement also needs so be evaluated in a well-designed study. Overall, further research is needed to investigate the best treatment for large-volume BPH and to address limitations of current studies.
Recommended Citation
Greenwood, Jessica, "The Efficacy of Aquablation in the Treatment of Large Volume Benign Prostatic Hypertrophy" (2020). Capstone Showcase. 72.
https://scholarworks.arcadia.edu/showcase/2020/pa/72
The Efficacy of Aquablation in the Treatment of Large Volume Benign Prostatic Hypertrophy
Introduction:
Benign Prostatic Hypertrophy (BPH) is a condition affecting adult males causing symptoms including urinary frequency, incontinence, and urinary retention. While first line treatment methods include lifestyle modifications and pharmacologic therapies, many patients elect for surgical procedures for symptomatic relief. In patients with extremely large volume prostates the surgical method most commonly used has been an open prostatectomy, which is associated with both long-term efficacy and more surgical complications than minimally invasive techniques. Therefore, this review analyzes Aquablation (I) for symptom management (O) in patients diagnosed with BPH (P) compared to open prostatectomy (C).
Methods:
A literature search was conducted in November 2018 using PubMed and Google Scholar. Seven studies were included which compared symptomatic relief in those undergoing open prostatectomies and Aquablation interventions. Selected studies included prospective, cohort, and randomized control trials. The overall study design, validity, and results were analyzed and compared.
Results:
In two studies directly evaluating Aquablation, there was a statistically significant change in IPSS for the large volume prostates. In one of these, PVR, QMAX, and QOL were significantly improved, whereas the other study found no improvement. Another study that assessed a minimally invasive technique compatible to aquablation found significant improvement in IPSS and Qmax. The three studies evaluating open prostatectomies found significant improvements in IPSS, PVR, and Qmax, and QOL. All of these studies except one followed up for at least 6 months.
Discussion:
All studies showed some symptomatic improvement after intervention, which is the goal for treatment modalities. However, there were no studies directly comparing Aquablation to open prostatectomies. Some of the aquablation studies did not evaluate all outcome measurements and lacked long-term data. Additionally, many studies were not double blinded, nor randomized control trials.
Conclusion:
Though aquablation demonstrates some symptomatic improvement, not every study had the same results or evaluated all outcome measures. Without a more thorough evaluation of all outcome measures, or direct comparison to open prostatectomy, a change in the gold standard treatment cannot be recommended. While this analysis did not look at safety measures, minimally invasive techniques tend to be safer than surgery. However, this statement also needs so be evaluated in a well-designed study. Overall, further research is needed to investigate the best treatment for large-volume BPH and to address limitations of current studies.