Combination Prostatic Artery Embolization Prior to Water-Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy:...

Area of Science:

• Urology
• Interventional Radiology
• Minimally Invasive Surgery

Background:

• Benign prostatic hyperplasia (BPH) is a common condition requiring treatment.
• Water-jet ablation and prostatic artery embolization (PAE) are treatment options for BPH.
• The combination of PAE and water-jet ablation for BPH has not been extensively studied regarding post-operative bleeding.

Purpose of the Study:

• To compare post-operative bleeding outcomes in patients undergoing water-jet ablation alone versus those who had PAE prior to water-jet ablation.
• To evaluate the safety and efficacy of combined PAE and water-jet ablation for BPH treatment.

Main Methods:

• Retrospective review of 145 BPH patients treated between December 2018 and June 2021.
• Patients were divided into two groups: water-jet ablation alone (n=56) and pre-operative PAE followed by water-jet ablation (n=89).
• Comparison of post-operative bleeding measures, urinary retention rates, and reoperation rates.

Main Results:

• Prostatic artery embolization (PAE) was successful in all 89 patients.
• The PAE + water-jet ablation group showed significantly reduced post-operative bleeding (lower rates of continuous bladder irrigation, hemostatic measures, hematuria).
• Pre-operative PAE was associated with lower rates of urinary retention (OR 17, p=0.02) and reduced need for 30-day reoperation (p=0.003).

Conclusions:

• Pre-operative PAE followed by water-jet ablation leads to fewer bleeding-related complications compared to water-jet ablation alone.
• The combination therapy also demonstrated a reduction in post-operative urinary retention.
• No major PAE-related adverse events were reported in the combined treatment group.