Tranexamic acid and hematuria outcomes following aquablation for benign prostatic hyperplasia

Aquablation is a robotic-assisted, water jet-based transurethral therapy for benign prostatic hyperplasia (BPH). Concerns about postoperative hematuria led to the practice of limited transurethral resection (TUR) with cauterization. This study aimed to assess the impact of tranexamic acid (TXA) on hematuria outcomes when combined with limited TUR after Aquablation.

We retrospectively analyzed men undergoing Aquablation at our institution (October 2020-July 2024). Demographic, prostate, surgical, and hematuria outcomes were extracted from electronic medical records. Kruskal-Wallis test compared medians.

Of 131 patients, 113 (86%) had limited TUR; 31 (27%) received 1 g TXA perioperatively. TXA patients had larger prostates (86 g vs. 70 g, p = 0.003). No TUR patients, with or without TXA, required transfusion. Among TUR patients, TXA did not significantly affect preoperative, postoperative, or postoperative day-one hemoglobin. Patient-initiated communications and emergency visits for hematuria were minimal and similar between groups. Hematuria outcomes were independent of prostate size, TUR volume, or TUR-to-prostate ratio. Subgroup analysis (<80 g vs. ≥80 g) showed no TXA effect. No TXA recipient had a thromboembolic event within 30 days. At one month, median urinary flow increased by 12.8 mL/sec interquartile range [IQR]: 8.7-18.8, and median International Prostate Symptom Score (IPSS) decreased by 7 (IQR: 3-12).

Limited TUR during Aquablation provides effective hemostasis. TXA had minimal impact on bleeding and was not associated with thromboembolic events. Routine TXA use should be reconsidered when limited TUR is performed.