Aquablation for benign prostatic obstruction: Single center technique evolution and experience

Aquablation is a new technology that relies on real-time ultrasound guidance to ablate prostatic tissues using high velocity pressurized water. We hereby present our data and experience in this technique by exploring the perioperative surgical and functional outcomes.

This is a prospectively filled study including consecutive patients who underwent aquablation at our Middle Eastern tertiary care center. Patient demographics, voiding parameters, and prostate disease specific variables were collected. We reported on the surgical and functional outcomes as well as the 3-month adverse events. We also explored the trend in hemoglobin drop and hemostasis method by dividing the consecutive cases into four temporal periods.

Fifty-nine patients underwent aquablation between March 2018 and March 2020. Mean time from transrectal ultrasound to Foley insertion was 48.5±2.5 minutes. Cautery was performed in 35 patients (59.3%) and a catheter-tensioning device was mounted in 50 patients (84.7%). On average, the hemoglobin dropped by -1.7±0.2 ng/dL (p<0.0001). The average length of catheterization and hospital stay were 2.1±0.3 days and 2.2±0.1 days, respectively. Only three patients (5.1%) were re-hospitalized. At three months, the average drop in serum prostate-specific antigen was -36.6±6.0% (p<0.0001) and functional outcomes considerably improved. We also recorded 14 adverse events in 13 patients (overall rate of 22.0%), with grade 1 and grade 2 complications comprising 71.4% of all adverse events.

Our study results confirm the safety and efficacy of the aquablation procedure in the adoption phase.