in the last decade, lots of attemps have been done to identify new technologies able to reply the efficacy of gold standard technique for treating BPH, but with a better safety profile. The introduction of laser techniques allowed to reduce complication rates. Among these, considerable importance had Holep and PVP. Aquablation is a recent technique for LUTS treatment. It is minimally invasive, robot-assisted and ultrasound-guided to ablate the prostate in targeted way and in heat-free way. It works with high pression water jet.~However, in literature informations about disobstructive capacity of minimally invasive techniques, evaluated with invasive urodynamic tests, are low.~In particular, about Aquablation, just in one trial is reported the reduction of BOOI, from 49 to 24 in 6 months after surgery, but this information is not associated with standard deviation and statistical significance.~Perreira-Carreia, J.A. et al, in 2012 reported a medium BOOI variation after 6 months by surgery, from 60 to 8,7 (p<0,001) even if procedure was conducted with laser 120 W.~In 2014 Know, O. and coll., reported BOOI reduction after Holep from 54,9 ± 30,2 to 3,4 ± 17,4 (p<0,001).~Actually, there are not trials comparing Aquablation with others mininvasive techniques to treat LUTS by BHP (in particular Holep and PVP).~This comparison is very interesting because of the specific benefits of each technique.~General and specific aims:~non inferiority evaluation of the BOOI variations in patients with LUTS caused by cervico-urethral obstruction by BHP undergone to endoscopic surgery with aquablation versus patients operated with laser endoscopic surgery (primary goal);~Evaluation of the IPSS score variations in two groups of patients,~Evaluation of Qmax variations with uroflowmetry and post-voiding residue in two groups;~Evaluation of sexual satisfaction by IIEF-5 survey and evaluation of presence of anejaculation in two groups;~Evaluation of total-PSA variation in two groups;~Evaluation of operative times, hospitalization and variations of haemoglobin and haematocrit value in two groups;~Evaluation of appearing of side effects (grade 1 and ≥ 2 by Clavien-Dindo) occurred in perioperative period and at 1, 3 and 6 months after surgery;~Inclusion criteria:~age ≥ 40 years and <90 years;~moderate-to-severe lower urinary tract symptoms (IPSS ≥ 12)~poor efficacy or tolerance to medical therapy for BPH~transrectal ultrasound prostate volume between 30 and 120 ml~ability to express written informed consent.~Exclusion criteria:~previous surgical treatments for BPH~indwelling bladder catheter or clean intermittent catheterization~bladder stones~severe detrusor hypocontractility (BCI <50) or detrusorial acontractility~urethral strictures~neurological bladder~not replaceable anticoagulant or antiplatelet drugs for severe cardiological comorbidity~bladder cancer;~diagnosis or clinical suspicion of prostatic cancer;~Treatment The enrolled subjects will undergo surgical treatment with one of the techniques under study: Aquablation, HoLEP or PVP.~The study population will be divided into two cohorts based on prostate volume measured by transrectal ultrasound. Thereafter, patients with a prostate volume between 30 and 65 ml will be assigned to the aquablation arm or PVP arm, while patients with a prostate volume over 65 ml will be subjected to aquablation or HoLEP. The assignment to each of the arms will be randomized, using an on-line software for block randomization.~Follow-up:~Follow-up visits will be conducted by a blinded research team. Outpatient visits will be performed at 1, 3 and 6 months after the surgical treatment. During the sixth month visit an invasive urodynamic examination will be performed with cystomanometry and pressure-flow study.
in the last decade, lots of attemps have been done to identify new technologies able to reply the efficacy of gold standard technique for treating BPH, but with a better safety profile. The introduction of laser techniques allowed to reduce complication rates. Among these, considerable importance had Holep and PVP. Aquablation is a recent technique for LUTS treatment. It is minimally invasive, robot-assisted and ultrasound-guided to ablate the prostate in targeted way and in heat-free way. It works with high pression water jet. However, in literature informations about disobstructive capacity of minimally invasive techniques, evaluated with invasive urodynamic tests, are low.~The enrolled subjects will undergo surgical treatment with one of the techniques under study: Aquablation, HoLEP or PVP.~Outpatient visits will be performed at 1, 3 and 6 months after the surgical treatment. During the sixth month visit an invasive urodynamic examination will be performed