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Transfusion rates after 800 Aquablation procedures using various haemostasis methods.

Dean Elterman1, Thorsten Bach2, Enrique Rijo3

  • 1Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada.

BJU International
|January 5, 2020
PubMed
Summary

Athermal methods for Aquablation therapy showed increased transfusion risks with larger prostates. Standard traction and selective cautery significantly reduced transfusion rates across all prostate sizes, proving more effective for benign prostatic hyperplasia treatment.

Keywords:
Aquablation therapybenign prostatic hyperplasialower urinary tract symptomsrobotictransfusions

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Area of Science:

  • Urology
  • Surgical Technology
  • Medical Device Innovation

Background:

  • Aquablation therapy, utilizing the AQUABEAM robot since 2014, is a minimally invasive treatment for benign prostatic hyperplasia.
  • Previous studies have explored various aspects of Aquablation, but the comparative effectiveness of different hemostatic techniques in reducing transfusion rates requires further clarification.

Purpose of the Study:

  • To evaluate the efficacy of athermal hemostatic techniques compared to cautery in preventing blood transfusions after Aquablation for benign prostatic hyperplasia.
  • To analyze the impact of prostate volume and traction methods on transfusion risk during Aquablation therapy.

Main Methods:

  • A pooled analysis of clinical trial data and early commercial procedures from 2014 to early 2019, involving 801 patients treated with Aquablation.
  • Comparison of transfusion rates between patients who underwent athermal methods with robust traction (using a catheter-tensioning device - CTD) versus those who used standard traction with selective bladder neck cautery.

Main Results:

  • A total of 3.9% (31 out of 801) patients required transfusions.
  • Athermal methods with robust traction showed an increased transfusion risk (0.8% to 7.8%) with larger prostate volumes (20-280 mL).
  • Standard traction with selective bladder neck cautery resulted in a transfusion risk of 1.4-2.5% across all prostate sizes.

Conclusions:

  • Athermal methods with robust traction are associated with a significant increase in transfusion risk as prostate volume increases.
  • Standard traction combined with selective bladder neck cautery effectively minimizes transfusion risk, regardless of prostate size.
  • Selective bladder neck cautery alongside standard traction is a superior hemostatic strategy for reducing transfusion rates in Aquablation therapy for benign prostatic hyperplasia.