Page 9 - CUA2019 Abstracts - Endourology

2019 CUA AbstrACts

Podium Session 1: Endourology, BPH, Robotics

June 29, 2019; 1500–1600

POD-1.1 POD-1.2
WATER II: Aquablation therapy for benign prostatic hyperplasia Demonstration of an effective ultra-low-dose computed
(80–150 cc) 12-month safety and efficacy results tomography protocol with lower radiation dose than abdominal
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Naeem Bhojani , Dean S. Elterman , Ryan F. Paterson , Alan I. So , S. Larry x-ray
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Goldenberg , Ronald P. Kaufman Jr. , James E. Lingeman , Steven Kaplan , Kymora Scotland , Jean Buckley , Savvas Nicolaou , Charles Zwirewich ,
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Mitchell Humphreys , Kevin Zorn , Claus Roehrborn ; submitted on behalf Patrick McLaughlin , Ben H. Chew
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of the WATER II investigators 1 Urologic Sciences, University of British Columbia, Vancouver, BC, Canada;
1 Urology, Université de Montréal, Montréal, QC, Canada; Urology, 2 Radiology, University of British Columbia, Vancouver, BC, Canada
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University of Toronto, Toronto, ON, Canada; Urology, University of British Introduction: Computed tomography of the kidneys, ureters, and bladder
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Columbia, Vancouver, BC, Canada; Urology, Albany Medical College, (CT-KUB) is the gold standard to identify renal calculi. However, its use is
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Albany, NY, United States; Urology, Indiana University, Indianapolis, IN, concerning for radiation exposure, particularly in recurrent stone-formers.
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United States; Urology, Icahn School of Medicine at Mount Sinai, New At this institution, KUB x-rays are routinely performed immediately prior to
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York, NY, United States; Urology, Mayo Clinic Arizona, Scottsdale, AZ, shockwave lithotripsy (SWL). Recent advances have made sub-milliSievert
United States; Urology, UT Southwestern Medical Center, Dallas, TX, (mSv) ultra-low-dose CT (ULDCT) acquisition feasible, but their diagnostic
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United States performance in comparison with KUB x-ray (KUB) has not been reported.
Introduction: In a large, blinded, multicentre, randomized trial (WATER), In this prospective study, we compare the radiation dose and diagnostic
Aquablation (AquaBeamSystem, PROCEPT BioRobotics, Inc., U.S.), an performance of ULDCT to KUB in patients prior to SWL. We hypothesized
ultrasound-guided, robotically executed waterjet ablative procedure, dem- that ULDCT will detect more symptomatic calculi than KUB at less radia-
onstrated improved urinary symptom scores that were comparable to those tion exposure prior to SWL.
found after transurethral resection of the prostate (TURP) in men suffering Methods: Patients were enrolled prospectively to receive a KUB and ULDCT
from benign prostatic hyperplasia (BPH) with gland sized from 30–80 cc. prior to SWL. If no stones were identified, they received a standard low-
In a previous study, subset analysis revealed that patients with larger gland dose abdominal CT. Radiation exposure parameters were recorded and
sizes demonstrated better outcomes with Aquablation compared to TURP. both examinations were read in random order by two blinded radiologists
These observations identified the need to assess the safety and efficacy of to determine image quality and diagnostic accuracy.
performing Aquablation in men with larger prostate glands (80–150 cc) Results: A total of 102 patients with a mean age of 55.7±13.8 years were
(WATER II). Herein, we report the 12-month outcomes. enrolled. ULDCT detected stones with 95% sensitivity and 98% specific-
Methods: A total of 101 men with moderate-to-severe BPH symptoms and ity with effective radiation dose 48% lower (0.28±0.08 mSv) compared to
prostate volumes of 80–150 cc underwent a robotic-assisted Aquablation KUB (0.54±0.11 mSv; p<0.001). Negative and positive predictive values
procedure in a prospective, multicentre, international clinical trial. Baseline were 95% and 98% for ULDCT (83%, 92% for KUB). Measurement of
demographics and standardized postoperative management parameters stone size was equivalent using ULDCT (6.47±3.34 mm) compared to
were carefully recorded in a central independently monitored database. KUB (6.98±3.41 mm; p=0.455); however, in 12 cases (14.5%), ULDCT
Functional and safety outcomes were assessed at 12 months postoperatively. localized stones undetected on KUB. ULDCT reduced the requirement for
Results: Mean prostate volume was 107 cc (range 80–150). Mean opera- repeat conventional dose CT-KUB.
tive time was 37 minutes and mean Aquablation resection time was eight Conclusions: ULDCT delivers 48% less radiation than a KUB radiograph
minutes. The average length of hospital stay following the procedure was and is superior at detecting the number and size of stones. In 14.5% of
1.6 days. Mean International Prostate Symptom Score (IPSS) improved from cases, ULDCT identified and localized ureteric stones prior to SWL that
23.2 at baseline to 6.2 at 12 months (p<0.0001). Mean IPSS quality of life were not seen on KUB. ULDCT can be safely and effectively used in recur-
improved from 4.6 at baseline to 1.3 at 12-month followup (p<0.0001). rent stone-formers with smaller radiation dose than low-dose CT.
Significant improvements were seen in peak flow rate (Qmax) (12-month
improvement of 12.5 cc/sec) and post-void residual (PVR) (drop of 171 POD-1.3
cc in those with PVR>100 at baseline). Antegrade ejaculation was main- Predicting ureteric stone expulsion with patient-reported
tained in 81% of sexually active men. No patient underwent a repeat outcomes: A prospective, observational study
procedure for BPH symptoms. There was a 2% de novo incontinence rate 1 1 1 1
at 12 months and 10 patients did require a transfusion postoperatively, Ryan McLarty , Mark Assmus , Tim Wollin , Shubha De
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while five required take back fulgurations. At 12 months, prostate-specific Division of Urology, University of Alberta, Edmonton, AB, Canada
antigen (PSA) decreased from 7.1±5.9 ng/mL at baseline to 4.4±4.3 ng/mL. Introduction: Many outcome-based studies have used patient-reported
Conclusions: The Aquablation procedure is demonstrated to be safe and accounts to establish stone passage rates, however, little data exists regard-
effective in treating men with large prostates (80–150 cc) after one year of ing the accuracy of such assessments. We sought to prospectively quantify the
followup, with an acceptable complication rate and without a significant accuracy of patient-reported variables on true ureteric stone expulsion rates.
increase in procedure or resection time compared to smaller-sized glands. Methods: New patients presenting to the University of Alberta stone clinic
This paper has figures, which may be viewed online at: were prospectively surveyed between April 2016 and November 2017.
https://2019.cua.events/webapp/lecture/272 Current patient symptoms and an assessment of whether or not they believed
they had passed their stone were assessed. Exclusion criteria included non-
ureteric stones, sepsis, and prior ureteric stent or intervention for the cur-
rent stone episode. The primary outcome was radiographic stone passage
as confirmed by ultrasound and kidneys-ureters-bladder (KUB) computed
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S77
© 2019 Canadian Urological Association