Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) Abnormal Uterine Bleeding Safety Study (AQTH-EA-22)

A Pre-Market, First-In-Human, Pilot, Interventional, Clinical Investigation to Evaluate the Safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) in Premenopausal Women With Abnormal Uterine Bleeding (AUB).

Abnormal uterine bleeding (AUB) is defined as "flow outside of normal volume, duration, regularity, or frequency". Acute AUB is excessive bleeding that requires immediate intervention to prevent further blood loss. Chronic AUB refers to irregularities in menstrual bleeding for most of the previous 6 months. AUB can be frequent or infrequent, prolonged, irregular, or heavy. Heavy menstrual bleeding (HMB) is defined as "excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life". Causes of AUB are classified as polyps, adenomyosis, leiomyomas (AUB-L), malignancy and premalignant conditions, coagulopathy, ovulatory disorders (AUB-O), endometrial disorders (AUB-E), iatrogenic, and ''not classified'' . AUB affects approximately one in four women between 30 and 50 years of age, with serious implications on woman's quality of life (QoL). Endometrial ablation (EA) is a uterus-preserving procedure that aims to destroy or remove the endometrial tissue in selected women who have no desire for future fertility. EA has become an alternative to hysterectomy in the treatment of AUB because it is less invasive and has a shorter recovery period. At present, many different techniques are available to remove the endometrial tissue. Resectoscopic endometrial ablation (REA) consists of targeted endometrial destruction under direct hysteroscopic visualization. REA techniques include endometrial laser ablation, transcervical resection of the endometrium, and rollerball endometrial ablation. Non-resectoscopic endometrial ablation (NREA) uses a variety of energy sources to non-selectively destroy the endometrial lining and include thermal balloon endometrial ablation, microwave endometrial ablation, hydrothermal ablation, bipolar radiofrequency endometrial ablation, endometrial cryotherapy, and more recently vapor endometrial ablation. NREA technologies require short surgical time and can also be performed in the outpatient setting. Vapor EA is one of the newest approaches in the field. In this context, the Aqua Therapeutics Thermal Therapy Vapor Ablation system (ATTTVAS; AQUA Therapeutics Inc.) is a novel system designed to ablate uterine tissue using vapor thermal therapy technology.

The ATTTVAS is indicated to ablate the endometrial lining of the uterus in premenopausal women with abnormal uterine bleeding (AUB) due to benign causes for whom childbearing is complete. In this Pre-Market, First-In-Human, Pilot, Interventional, Clinical Investigation we aim to evaluate the Safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) in premenopausal women with AUB.

Study Overview

• Status: Completed
• Conditions: Uterine Hemorrhage
• Intervention / Treatment: Device: Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS)

Detailed Description

The Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) is a system designed to ablate uterine tissue by vapor thermal therapy technology. The ATTTVAS consists of a reusable Generator, a DISPOSABLE APPLICATOR, a DISPOSABLE CATHETER and a SYRINGE.

The ATTTVAS is intended for outpatient use although it can easily be utilized in both a surgery centre and the operating room as well. This is a Pre-Market, First-In-Human, Pilot, Interventional, Clinical Investigation to Evaluate the Safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) in premenopausal women with AUB. For each patient, a total of 6 visits (5 on-site and 1 remote) will be planned according to the flowchart. Unscheduled visit(s) will be planned on-site according to Principal Investigator judgement. Each Subject, after signing the Informed Consent Form (ICF), will enter a screening phase (V-1) during which several assessments (e.g., demographics, medical history, current menstrual condition, blood analysis) will be conducted. At the screening visit, patients will receive a menstrual calendar and a PBAC to be completed. The PBAC score must be recorded as soon as available to confirm that the patient can be enrolled at baseline (PBAC must be ≥150). The PBAC score will also be recorded at the End of Study (EOS) visit. At baseline (V0) and at EOS, on site, patients will also complete the Menorrhagia Impact Questionnaire (MIQ). If the Investigator can complete all the assessments foreseen at baseline visit (V0) and V1-EA in one day, V0 and V1 may coincide. At V1, enrolled Subjects will undergo EA with the ATTTVAS. EA must be performed within 15-20 days from the beginning of the menstrual cycle. EA cannot be performed in the presence of heavy menstrual bleeding, but it can be performed in the presence of light bleeding/spotting. Sedation will be performed before the EA by intravenous administration of propofol and fentanyl. The duration (seconds) of the ablation cycle will be recorded on the CRF. After the procedure is completed, the PI will fill a questionnaire on procedural ease of use. Device deficiencies (if any) will be recorded. At discharge, after 24 hours and 1 week from discharge, patients will be asked to rate pain intensity on a Numeric Rating Scale (NRS). At discharge patients will receive a diary to record AEs and concomitant medications through the study period. Follow-up visits will be performed after 1 week and 6 weeks from discharge. Satisfaction with the procedure will be evaluated using a 5-Likert Scale (completed by patient and PI) at discharge and at EOS. Physical examination, monitoring of vital signs and AEs will be performed at each applicable visit. Current menstrual condition will be monitored during the entire study period. To evaluate the need for surgical or medical intervention to treat AUB after EA, any surgical or medical intervention required to treat AUB after EA will be recorded during the study. An Interim Analysis was performed on the clinical data collected from V-1 to EOS (included) for the first 5 patients enrolled. The primary aim of the interim analysis was to evaluate the safety of the medical device. During the interim analysis, the enrollment of patients stopped. The results of the interim analysis were submitted to the Ethic Committee (EC) and Competent Authority (CA). Based on the interim analysis results and, after EC/CA feedback, the study activities could continue as planned.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • Milan, Italy
    • Milano
  • Roma, Italy
    • Roma
• Netherlands
  • Veldhoven, Netherlands
    • Veldhoven

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Signed patient informed consent form (ICF).
2. Females aged ≥ 30 years and ≤ 55 years at baseline with no desire to conceive, with or without simple endometrial hyperplasia (without atypia).
3. Diagnosis of AUB.
4. Premenopausal (follicle-stimulating hormone level ≤ 40 mIU/mL), women who don't want to receive hormonal treatment or who have failed to respond to hormonal treatment.
5. Pictorial Blood Loss Assessment Chart (PBAC) score ≥150 at baseline.
6. Normal endometrial biopsy.
7. Negative PAP test.
8. Willingness to follow all study procedures, including attending all site visits, tests, and examinations.

Exclusion Criteria:

1. BMI ≥35
2. Postmenopausal status.
3. Undiagnosed vaginal bleeding.
4. A patient with a history of a prior completed endometrial ablation procedure and/or endometrial resection (including endometrial ablation/resection performed immediately prior to the ATTTVAS Ablation Treatment) regardless of the modality by which it was performed.
5. Previous uterine surgery.
6. Not willing to avoid the use of vaginal ring, hormonal intrauterine device (concomitant IUD such as Essure is not allowed prior to the ATTTVAS Ablation Treatment), oral contraceptives during the study period.
7. Pregnant or breastfeeding.
8. Less than 1-year post-partum.
9. Any contraindication to endometrial ablation.
10. History of previous classical cesarean section or transmural myomectomy, including hysteroscopic and/or laparoscopic myomectomy performed immediately prior to the ATTTVAS Ablation Treatment.
11. Confirmed pelvic inflammatory disease, active/acute endometritis, sexually transmitted disease, bacteremia, sepsis, other active local and/or systemic infection.
12. Active genital or urinary tract infection (e.g., cervicitis, vaginitis, endometritis, salpingitis or cystitis) at the time of treatment.
13. Congenital malformations of the female genital tract.
14. Subjects with suspected or known coagulopathies or receiving anticoagulation therapy.
15. A patient currently on medications that could thin the myometrial muscle, such as long-term steroid use (except for inhaler or nasal therapy for asthma).
16. Documented cervical dysplasia, complex or atypical endometrial hyperplasia, abdominal or pelvic cancer.
17. Presence of any relevant severe condition or clinically relevant abnormal laboratory parameters that in the opinion of the Investigator may interfere with the participation to the study.
18. Presence of any relevant severe organic, systemic, or metabolic disease (particularly significant history of cardiac, renal, neurological, psychiatric, oncology, endocrinology, metabolic or hepatic disease), or abnormal laboratory values that will be deemed clinically significant in Investigator's opinion.
19. Active malignant neoplasm of any type, or history of a malignancy (patients with a history of other malignancies that have been surgically removed and who have no evidence of recurrence for at least five years before study enrollment are also acceptable).
20. Participation in another investigational study within the previous 30 days.
21. Recent history or suspicion of alcohol abuse or drug addiction.
22. Inability to follow study procedures.
23. History of allergic reactions to propofol and/or fentanyl.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Treatment with Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) medical device; All Patients shall be screened for initial study eligibility by the Principal Investigator at the investigational site. Potential candidates, that according to the investigator judgment should be treated with IP, will be identified, with the assessment of their eligibility criteria, by the study site Principal Investigator and research staff. Patients will be considered to be enrolled in the study once they have met all of the inclusion and none of the exclusion criteria. Patients who do not meet the criteria will not be enrolled in the study. The patient involvement in the study will last until the EOS visit.

Device: Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS); The Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS) is indicated to ablate the endometrial lining of the uterus in premenopausal women with abnormal uterine bleeding (AUB) due to benign causes for whom childbearing is complete. The ATTTVAS is intended to be used by qualified healthcare professionals specifically trained in the field of endometrial ablation. The ATTTVAS is intended for outpatient use although it can easily be utilized in both a surgery centre and the operating room as well.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To evaluate the safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS). Safety will be monitored through vital sign.	Safety will be monitored through Blood pressure measurement. Blood pressure (both pressures) readings are typically expressed in millimeters of mercury (mmHg)	V1 (day 2, Endometrial ablation) V3 (1 week after V1) and V4 (6 weeks after V1) and unscheduled visit (between V1 and V4)
To evaluate the safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS). Safety will be monitored through vital signs.	Safety will be monitored through Heart Rate measurement. Heart rate is the frequency of the heartbeat measured by the number of contractions of the heart per minute (beats per minute, or bpm)	V1 (day 2, Endometrial ablation) V3 (1 week after V1 ) and V4 (6 weeks after V1)and unscheduled visit (between V1 and V4)
To evaluate the safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS). Safety will be monitored through vital signs.	Safety will be monitored through measurement of the oxygen levels. 2 refers to the percentage of oxygen-saturated hemoglobin relative to total hemoglobin in the blood. The measurement of O2 is performed using a non-invasive device known as a pulse oximeter.	V1 (day 2, Endometrial ablation) V3 (1 week after V1 ) and V4 (6 weeks after V1) and unscheduled visit (between V1 and V4)
To evaluate the safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS). Safety will be monitored through laboratory data	Blood analyses will include: - Hemoglobin g/dL	V-1 (within 40 days before baseline); V4 (6 weeks after V1)
To evaluate the safety of the Aqua Therapeutics Thermal Therapy Vapor Ablation System (ATTTVAS). Safety will be monitored through laboratory data	Blood analyses will include: - Hematology: complete blood count (including red blood cell count, white blood cell count, platelet count)	V-1 (within 40 days before baseline); V4 (6 weeks after V1)
Safety will be monitored through the reporting of the adverse events, serious adverse events and concomitant medications during the entire study duration.	The event, date of onset, severity, duration, and relationship to the device will be recorded. Subjects will receive a diary to record any deviation from the normal health status as well as any concomitant medication taken.	V-1 (within 40 days before baseline); V0 (day 1 Baseline) V1 (day 2, Endometrial ablation and at discharge) V2 (phone call after 24h after discharge); V3 (1 week after V1 ) and V4 (6 weeks after V1) and and unscheduled visit (between V1 and V4)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To evaluate the change of menstrual blood loss, the pictorial blood loss assessment chart (PBAC) score will be assessed	PBAC is a visual tool used to estimate menstrual blood loss. The PBAC uses a set of pictures that represent different levels of blood flow during menstruation. Users compare their own blood flow to the pictures to estimate their menstrual blood loss. The patients should record the number of tampons and sanitary pads used each day during the bleeding episode by placing the number under the day and next to the box representing the amount of bleeding each time the patient change pad or tampon. The patients should Record clots by indicating whether they are the size of a coin in the small and large blood clot row under the appropriate day.	V0 (day 1 Baseline) and V4 (6 weeks after V1)
To evaluate the effect of menstrual blood loss on the quality of life	To evaluate the effect of menstrual blood loss on the quality of life, the Menorrhagia Impact Questionnaire (MIQ) will be completed by patients. MIQ is instrument for Bleeding-specific symptom and quality of life that measures impact of heavy menstrual bleeding with six items total on perceived amount of blood lost, impact on work, impact on physical activities, social activities, number of activities limited, and perceived impact of treatment on symptoms. Total MIQ score range: 4 to 21. Higher scores indicate a worse menorrhagia-related quality of life, meaning greater perceived menstrual blood loss and greater interference with daily, social, physical, and work activities.	V0 (day 1 Baseline) and V4 (6 weeks after V1)
To evaluate pain intensity after treatment.	To evaluate pain intensity after treatment, a Numeric Rating Scale (NRS) - with 0 representing no pain and 10 representing unbearable pain will be used.	V1 (day 2, at discharge) V2 (phone call after 24h after V1); V3 (1 week after V1)
To evaluate procedure difficulty.	To evaluate the procedural ease of use, a questionnaire will be completed by the Investigator on the day of treatment. The PI will compile a multiple choice questionnaire and answer to some questions on procedural ease of use.	V1 (day 2 after Endometrial Ablation)
To evaluate menstrual changes (menstrual frequency, duration, regularity).	To monitor menstrual changes (menstrual frequency, duration, regularity), a menstrual calendar will be used by the patient	V-1 (within 40 days before baseline); V0 (day 1 Baseline) V2 (phone call after 24h after V1); V3 (1 week after V1) and V4 (6 weeks after V1)
To evaluate patient's satisfaction with the ATTTVAS.	To evaluate patient's satisfaction with the ATTTVAS, a 5-Likert Scale will be used. Here's a breakdown of a typical 5-point Likert scale: Strongly Disagree Disagree Neutral (or Neither Agree nor Disagree) Agree Strongly Agree This scale allows respondents to express the intensity of their feelings towards a given statement, making it easier to quantify subjective data. It's widely used because it's simple to understand and analyze.	V1 (day 2, at discharge) and V4 (6 weeks after V1)
To evaluate PI's satisfaction with the ATTTVAS.	To evaluate PI's satisfaction with the ATTTVAS, a 5-Likert Scale will be used. Here's a breakdown of a typical 5-point Likert scale: Strongly Disagree Disagree Neutral (or Neither Agree nor Disagree) Agree Strongly Agree This scale allows respondents to express the intensity of their feelings towards a given statement, making it easier to quantify subjective data. It's widely used because it's simple to understand and analyze.	V1 (day 2, at discharge) and V4 (6 weeks after V1)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of Device Deficiency/Incidents.	Device deficiency/incident information will be collected by the investigator or its delegates on the CRF's.	V1 (day 2 Endometrial Ablation)

Collaborators and Investigators

• Sponsor: Aqua Therapeutics, Inc.

Study record dates

Study Major Dates

• Study Start (Actual): November 28, 2024
• Primary Completion (Actual): December 1, 2025
• Study Completion (Actual): December 1, 2025

Study Registration Dates

• First Submitted: April 21, 2026
• First Submitted That Met QC Criteria: May 5, 2026
• First Posted (Actual): May 12, 2026

Study Record Updates

• Last Update Posted (Actual): May 12, 2026
• Last Update Submitted That Met QC Criteria: May 5, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Pathologic Processes; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Uterine Diseases; Genital Diseases, Female; Hemorrhage; Pathological Conditions, Signs and Symptoms; Uterine Hemorrhage
• Other Study ID Numbers: AQTH-EA-22

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No