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

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.