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Optimizing Patient Selection for Aquablation During the Initial Adoption Phase: Prostates Smaller Than 100 mL.

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Aquablation is safest for prostates under 100 mL, reducing operative time and irrigation volume. Accurate prostate volume (PV) estimation is crucial for successful Aquablation implementation.

Keywords:
Aquablationbenign prostatic hyperplasiabladder irrigationoperative timeprostate volume

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Surgical Technology

Background:

  • Aquablation is a novel robotic waterjet ablation system for benign prostatic hyperplasia (BPH).
  • Predicting operative time and irrigation volume is essential for safe implementation, especially during initial adoption by Aquablation-naïve urologists.

Purpose of the Study:

  • To identify predictors of operative time and bladder irrigation volume in patients undergoing Aquablation.
  • To establish criteria for optimal candidate selection during the early phase of Aquablation adoption.

Main Methods:

  • Retrospective analysis of 123 patients who underwent Aquablation.
  • Multivariable linear regression to assess preoperative predictors of operative time and irrigation volume.
  • Locally estimated scatterplot smoothing (LOESS) to define a prostate volume (PV) threshold.

Main Results:

  • Prostate volume (PV) was the sole independent predictor of longer operative times and higher irrigation volumes.
  • A PV threshold near 80 mL for irrigation and 100 mL for operative time was identified.
  • Patients with PV < 100 mL experienced shorter operative times, lower irrigation volumes, and less hemoglobin reduction compared to those with PV ≥ 100 mL.

Conclusions:

  • A prostate volume (PV) less than 100 mL is a practical criterion for the safe early adoption of Aquablation.
  • Accurate preoperative estimation of prostate volume is essential for successful Aquablation procedures.