Reproducibility of Aquablation outcomes across surgeon experience levels: A descriptive analysis of published studies.

Abstract

The objective of this study is to descriptively evaluate the reported functional and symptomatic outcomes of Aquablation therapy across published series categorized by operator experience level. We performed a non-systematic descriptive review of functional and symptomatic outcomes of eight published Aquablation clinical trials and real-world series. Studies were categorized based on inferred or known operator experience into early-experience (Water, Water II and Japan-PMS; total <i>n</i>&#x2009;=&#x2009;332) and experienced groups (Water III, ASC Pilot, ASC Global, Mount Sinai and Madrid; total <i>n</i>&#x2009;=&#x2009;664). Extracted variables included baseline and follow-up International Prostate Symptom Score (IPSS), IPSS-quality of life (QoL), maximum urinary flow rate (Qmax) and post-void residual volume (PVR). Weighted and sample-size weighted mean and standard deviation of change were calculated and evaluated descriptively. IPSS, IPSS-QoL, Qmax and PVR all improved across the eight cohorts. Mean changes in patient-reported outcomes were similar between early-experience and experienced cohorts for IPSS (unweighted mean change: -14.77 vs. -15.15; weighted: -14.81 vs. -15.30) and IPSS-QoL (unweighted: -3.13 vs.&#x2009;-3.28; weighted: -3.14 vs. -3.13). Physiologic metrics (QMax and PVR) demonstrated higher absolute improvements and greater variance in the experienced cohort, heavily driven by cohorts with more severe baseline urinary retention. Across published series, Aquablation yields broadly consistent improvements in patient-reported symptom scores, regardless of baseline operator experience level. Observed differences in physiological outcomes appear primarily influenced by baseline patient selection rather than surgeon experience. These descriptive findings support the general reproducibility of Aquablation outcomes across real-world clinical settings. Formal prospective studies are required to define reproducibility across perioperative safety profiles.