Aim of this systematic review is to evaluate functional outcomes (Qmax, QoL, IPSS, PVR), sexual outcome (erectile dysfunction and anejaculation rate), and adverse events evaluated according to the Clavien-Dindo classification.

The bibliographic search with the included terms (prostate, benign prostatic hyperplasia, benign prostatic enlargement, lower urinary tract symptoms, water jet dissection, aquablation, Aquabeam®) produced a literature of 32 articles altogether. After removing papers of not interest or articles which the outcomes could not be deduced, nine studies were examined for a total of 664 patients screened.

The functional outcomes, evaluated after water jet dissection, have shown improvement with respect to the baseline in all the selected articles. In the comparison papers with the TURP, the Aquablation has been statistically not inferior regarding functional outcomes. The sexual outcomes have highlighted a better ejaculation rate for water jet dissection than TURP. Regarding the adverse events, water jet dissection documented low rates of adverse events and, in comparison studies, were not statistically superior than TURP.

In our systematic review, the Aquabeam® System for the treatment of LUTS/BPH has proven to be a safe technique that provides functional outcomes comparable to TURP. About sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, other multicenter randomized trials with larger cohorts and longer follow-up are still needed.

International journal of impotence research. 2019 Jun 07 [Epub ahead of print]

Giulio Reale, Sebastiano Cimino, Giorgio Bruno, Fabiano Palmieri, Raimondo Giardina, Giorgio Ivan Russo, Enrico Grimaldi, Salvatore Voce, Giuseppe Morgia

Department of Surgery, Urology Section, University of Catania, Catania, Italy. ., Department of Surgery, Urology Section, University of Catania, Catania, Italy., Urology Division, S. Maria delle Croci Hospital, Ravenna, Italy.