SynthesisFrontiers in surgery2026
Aquablation versus laser enucleation of the prostate for benign prostatic hyperplasia: a systematic review and pairwise meta-analysis of head-to-head studies including the first randomized trial.
Synthesis in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
20 authors.
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Abstract
Background: Holmium/thulium laser enucleation of the prostate (LEP) is an established, size-independent surgical option for benign prostatic hyperplasia, while Aquablation is an emerging robotic waterjet therapy. Until recently, the two had never been compared in a randomized head-to-head trial, and the only prior quantitative synthesis relied on an indirect, transurethral resection of the prostate (TURP)-anchored network comparison. We conducted the first pairwise meta-analysis restricted to studies directly comparing Aquablation and LEP, incorporating the first partially randomized head-to-head trial. Methods: PubMed, Embase, Cochrane Library, and Scopus were searched for studies directly comparing Aquablation with HoLEP or thulium enucleation, following PRISMA 2020 and AMSTAR 2. The complete search strings for each database, the date of the final search, language and date restrictions, and the duplicate removal process. Outcomes were pooled using random-effects (DerSimonian-Laird) models as mean differences (MD) for continuous and risk ratios (RR) for dichotomous variables; outcomes exceeding Results: Of 126 records identified, 7 full-text articles were assessed for eligibility and 1 (ATHLETE) was excluded as a study protocol with no outcome data, leaving 6 studies: 1 partially randomized trial, 4 comparative cohorts ( Conclusions: No statistically significant difference in overall symptom relief was observed between Aquablation and laser enucleation, though a non-significant numerical trend in large glands is exploratory and requires confirmation. Aquablation confers markedly better, size-independent ejaculatory preservation, while laser enucleation provides superior objective deobstruction. Certainty of evidence remains low to moderate given the limited partially randomized base and short follow-up. These findings support an individualized choice between procedures based on gland size and patient priorities. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD420261439112, PROSPERO CRD420261439112.
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