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AQUABLATION: A SINGLE INSTITUTION EXPERIENCE OF 100 PATIENTS (2023)
Dylan Dangerfield, MD, Yates Congleton, MD, Tanner Wright, MD, Wesley White, MD, Ryan Pickens, MD
University of Tennessee at Knoxville, Department of Urology, Knoxville, TN, University of Tennessee at Knoxville, Department of Surgery, Knoxville, TN
Presented By: Ryan Baird Pickens, MD
Introduction
Aquablation is a novel surgical approach for BPH that has shown noninferiority to TURP in the WATER I and WATER II trials while demonstrating a lower risk of sexual dysfunction. The majority of published literature includes smaller case series data. We report our initial data with 100 patients.
Methods
In this single-center, single-surgeon study, 100 patients with moderate to severe LUTS related to BPH underwent Aquablation. The average age of men included was 71 years old.40 men had a history of urinary retention, 15 of whom required CIC preoperatively. Despite 87/100 (87%) of patients being on an alpha blocker, 5 alpha-reductase inhibitors, or combination therapy, the average preop IPSS score was documented as 28.8 with an average PVR of 327.3ml. The average prostate size was 123.6g (35-200g). IPSS and PVR were obtained at 6 weeks postoperatively and 6 months if available. Preoperative and 3-month postoperative PSA was also assessed.
Results
100 men underwent Aquablation with average operative time (defined as TRUS insertion to foley catheter placement), average ablation time, and transurethral resection times as noted in Figure 1. IPSS scores and PVR trends over time are demonstrated in Figure 2. Average preoperative PSA recorded at 8 with an average of 75% reduction noted 3 months postoperatively. Post-operative complications included 15 cases of urinary retention after initial foley catheter removal requiring CIC or replacement of indwelling foley catheter. Five patients required cystoscopy with clot evacuation and fulguration with 4 of the cases occurring in the first 40 cases before we adjusted our TUR technique. 10 of the 15 retention cases also occurred in the first 40 cases. No reports of de novo SUI or ED.
Conclusion
Early data appears to demonstrate Aquablation as an effective treatment for BPH with a procedure duration of less than 1 hour for large prostates while obtaining significant IPSS and PVR improvement similar to other BPH procedures. There does not appear to be a significant risk of sexual dysfunction associated.
Dylan Dangerfield, MD, Yates Congleton, MD, Tanner Wright, MD, Wesley White, MD, Ryan Pickens, MD
University of Tennessee at Knoxville, Department of Urology, Knoxville, TN, University of Tennessee at Knoxville, Department of Surgery, Knoxville, TN
Presented By: Ryan Baird Pickens, MD
Introduction
Aquablation is a novel surgical approach for BPH that has shown noninferiority to TURP in the WATER I and WATER II trials while demonstrating a lower risk of sexual dysfunction. The majority of published literature includes smaller case series data. We report our initial data with 100 patients.
Methods
In this single-center, single-surgeon study, 100 patients with moderate to severe LUTS related to BPH underwent Aquablation. The average age of men included was 71 years old.40 men had a history of urinary retention, 15 of whom required CIC preoperatively. Despite 87/100 (87%) of patients being on an alpha blocker, 5 alpha-reductase inhibitors, or combination therapy, the average preop IPSS score was documented as 28.8 with an average PVR of 327.3ml. The average prostate size was 123.6g (35-200g). IPSS and PVR were obtained at 6 weeks postoperatively and 6 months if available. Preoperative and 3-month postoperative PSA was also assessed.
Results
100 men underwent Aquablation with average operative time (defined as TRUS insertion to foley catheter placement), average ablation time, and transurethral resection times as noted in Figure 1. IPSS scores and PVR trends over time are demonstrated in Figure 2. Average preoperative PSA recorded at 8 with an average of 75% reduction noted 3 months postoperatively. Post-operative complications included 15 cases of urinary retention after initial foley catheter removal requiring CIC or replacement of indwelling foley catheter. Five patients required cystoscopy with clot evacuation and fulguration with 4 of the cases occurring in the first 40 cases before we adjusted our TUR technique. 10 of the 15 retention cases also occurred in the first 40 cases. No reports of de novo SUI or ED.
Conclusion
Early data appears to demonstrate Aquablation as an effective treatment for BPH with a procedure duration of less than 1 hour for large prostates while obtaining significant IPSS and PVR improvement similar to other BPH procedures. There does not appear to be a significant risk of sexual dysfunction associated.
