A systematic review and meta-analysis on the safety and efficacy of Aquablation
In brief
Aquablation cuts urinary symptom scores by 16 points, with gains lasting 3 years
Across 15 studies involving 1,580 patients, Aquablation reduced urinary symptom scores by about 16 points at 6 months, with improvement sustained to 36 months; urine flow also increased. Ejaculatory dysfunction occurred in 7.4%, transfusions in 2.5%, and no erectile dysfunction was reported. Results varied widely between studies, so the size of benefit and safety may differ across settings.
- Journal
- BJUI compass (Q1)
- Published
- 7 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Kimberley Chan, Nico Christian Grossmann, Matthew Feyissa, Jeremy Nettleton, Philip Charlesworth, Neil Barber, et al.
- PMID
- 42851274
- DOI
- 10.1002/bco2.70292
Why clinicians should know about it
- Picked for Urology (paper of the day, 11 October 2026): Systematic review of Aquablation for BPH
Abstract
OBJECTIVES: This work aimed to evaluate the efficacy and safety of Aquablation for the treatment of benign prostatic enlargement. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.