Initial Experience Performing "Cautery-Free Waterjet Ablation of the Prostate"

Herein, we describe our initial experience performing waterjet ablation of the prostate without electrocautery. A retrospective review of patients undergoing Aquablation for benign prostatic hyperplasia between February and September 2019 was performed. A standardized perioperative protocol for optimizing hemostasis was implemented. The primary endpoint was to define bleeding complications perioperatively and up to 30 days postoperatively after Aquablation. Bleeding complications included hematuria requiring prolonged continuous bladder irrigation, drop in hemoglobin requiring transfusion, or take back to operating room for evacuation of bladder clots and bladder fulguration. Bivariable analysis using Fisher's exact test and unpaired t-tests were used to identify factors associated with bleeding complications. Thirty-two patients underwent Aquablation over the study period. Average preoperative international prostate symptom score was 20 (range: 13-34) and Qmax was 7 mL/s (range: 0-11). Mean prostate volume was 65 cc (range: 30-200 cc). Average perioperative change in hemoglobin was 1.3 g/dL (range: -0.3 to 4.2 g/dL). Eight patients (25%) experienced bleeding complications. Three (9.4%) required blood transfusions. On Fisher's exact test, prostate volume (91 cc vs 55 cc; p = 0.0361) and preoperative prostate-specific antigen (6.6 vs 2.9; p = 0.0218) were associated with postoperative bleeding. Performing waterjet ablation of the prostate without the use of electrocautery after waterjet treatment to control bleeding resulted in significant bleeding complications (25% of our cohort) during our initial experience. A combination of traction and focal bladder neck electrocautery is the best strategy to minimize bleeding complications after Aquablation.