The introduction of minimally invasive techniques for BPH treatment aimed to balance de-obstruction with maintenance of ejaculatory function. The aim of this multicentric series was to compare outcomes of waterjet ablation therapy (WAT) versus urethral-sparing robot assisted simple prostatectomy (us-RASP) for large prostate volumes (PV>80 mL) according to BPH-6 metric.
Four institutional BPH datasets were matched and queried for "PV>80 mL" (N.=86), "WAT" (Group A; N.=42) and "us-RASP" (Group B; N.=44). Baseline, perioperative and functional data according to BPH6 composite endpoint were compared between groups. Differences between continuous variables were assessed with t-test or Mann-Whitney U-test depending on their normal or not normal distribution, while Chi-square Test was used for categorical data. A two-sided P<0.05 was considered significant.
Patients treated with WAT showed lower preoperative PSA median values (3.5 vs. 7.07 ng/mL) (P<0.05). Regarding perioperative outcomes, patients treated with us-RASP revealed increased median operative time (110 vs. 70 mins), prolonged bladder irrigation time (24 vs. 37.2 hours), longer median hospital stay (5 vs. 4 days), respectively (all P<0.05). At a median follow-up of 43.7 months (IQR 33.8-49.7), the BPH6 achievement rate was comparable between groups (54.7% vs. 56.8%; P=0.964). In the WAT series 1-year ejaculatory dysfunction rate was 19.1% while in the us-RASP cohort was 13.6%, respectively (P=0.21). Retrospective design and the lack of a propensity-score matching represent main limitations of this study.
Compared to us-RASP, WAT showed comparable symptom relief and ejaculatory function preservation for prostate gland >80 mL with benefit in terms of main perioperative outcomes at mid-term follow-up.
Minerva urology and nephrology. 2025 Apr [Epub]
Umberto Anceschi, Francesco Tedesco, Daniele Amparore, Eugenio Bologna, Giampaolo Siena, Loris Cacciatore, Salvatore Basile, Andrea Cocci, Francesco Prata, Rocco S Flammia, Sabrina De Cillis, Francesco Sessa, Alfredo M Bove, Lorenzo Viola, Andrea Iannuzzi, Alberto Ragusa, Aldo Brassetti, Riccardo Mastroianni, Gabriella Mirabile, Flavia Proietti, Leslie C Licari, Ashanti Zampa, Alberto Quarà , Michele Ortenzi, Enrico Checcucci, Cristian Fiori, Francesco Porpiglia, Andrea Minervini, Vito Pansadoro, Costantino Leonardo, Giuseppe Simone
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy - ., Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Department of Minimally-Invasive Oncologic Urology, Careggi University Hospital, Florence, Italy., Center of Minimally-Invasive Urology, Pio XI Clinic, Fondazione Vincenzo Pansadoro, Rome, Italy.