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Learning curve in aquablation: an international multicenter study.

Albert El Hajj1, Vincent Misrai2, Ali A Nasrallah3

  • 1Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. ae67@aub.edu.lb.

World Journal of Urology
|January 6, 2022
PubMed
Summary

Aquablation offers a rapid learning curve for benign prostatic obstruction treatment, achieving high safety and efficacy quickly. Key factors for faster learning include operative time reduction and improved surgical planning.

Keywords:
AquablationEndoscopyLearning curveLower urinary tract symptomsProstateProstatic hyperplasia

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Surgical Education

Background:

  • Benign prostatic obstruction (BPO) affects a significant number of men worldwide.
  • Aquablation therapy is a novel robotic waterjet ablation technique for BPO treatment.
  • Understanding the learning curve (LC) is crucial for widespread adoption and optimal patient outcomes.

Purpose of the Study:

  • To analyze the learning curve for aquablation in treating BPO.
  • To determine the number of cases required to achieve proficiency in safety, efficiency, and efficacy.
  • To identify factors influencing the learning curve.

Main Methods:

  • Retrospective analysis of prospectively maintained aquablation databases from multiple countries.
  • Defined trifecta (efficiency, safety) and pentafecta (effectiveness) outcomes.
  • Utilized moving average and polynomial fitting to plot the combined learning curve.

Main Results:

  • Trifecta achievement surpassed 50% after 4 cases and 70% after 50 cases.
  • Pentafecta achievement exceeded 50% after 38 cases.
  • Significant improvements noted in hemoglobin reduction and ejaculation preservation with experience; complication rates and symptom improvement were independent of experience.

Conclusions:

  • Aquablation demonstrates a quick learning curve for trifecta and pentafecta outcomes.
  • The procedure provides effective lower urinary tract symptom (LUTS) relief with low complication rates.
  • Hemoglobin drop and ejaculatory function preservation are influenced by surgeon experience; training and technique standardization are key for faster learning.