A systematic review and meta-analysis on the safety and efficacy of Aquablation.

Authors

Kimberley Chan, Nico Christian Grossmann, Matthew Feyissa, Jeremy Nettleton, Philip Charlesworth, Neil Barber, Jeremy Teoh, Ben Challacombe, Garrett Pohlman, Evangelos Liatsikos, Dean Elterman, Nikhil Vasdev

Published in

BJUI compass. Volume 7. Issue 10. Pages e70292. Epub Oct 07, 2026.

Abstract

This work aimed to evaluate the efficacy and safety of Aquablation for the treatment of benign prostatic enlargement.
A systematic review was conducted in accordance with PRISMA 2020 guidelines (PROSPERO CRD420261401865). A comprehensive PubMed search identified prospective studies and randomised controlled trials published up to January 2026. Studies including ≥30 patients reporting clinical outcomes of Aquablation were included. Guidelines, case reports, review articles, letters, retrospective studies with pooled data were excluded. Primary outcomes were International Prostate Symptom Score, maximum flow rate, postvoid residual and sexual function. Secondary outcomes included perioperative parameters and complications. Random-effects meta-analysis using DerSimonian-Laird was performed for outcomes reported in three or more studies.
Fifteen studies comprising 1580 patients were included. Mean age and prostate volume were 67.0 years and 82.1 cc, respectively. Aquablation significantly improved urinary outcomes, with a pooled IPSS reduction of -15.80 at 6 months (95% confidence interval [CI] -17.88 to -13.73; I ² = 97.8%), sustained to 36 months. Q _max increased by 11.0 mL/s (95% CI 8.93-13.02; I ² = 95.1%), while PVR decreased by 103.8 mL (95% CI -139.5 to -68.0; I ² = 98.1%) at 6 months. Ejaculatory dysfunction occurred in 7.4% of patients, with no reported erectile dysfunction. The transfusion rate was 2.5%, with lower rates observed using focal bladder neck cautery. Most complications were low grade.
Aquablation provides durable and significant improvements in urinary outcomes with a favourable safety profile and low rates of sexual dysfunction, supporting its role as an effective surgical option for BPE.

PMID:
42851274
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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