Phase-specific workflow maturation during early institutional implementation of Aquablation for benign prostatic...

Phase-specific workflow maturation during institutional Aquablation implementation remains incompletely characterized. We retrospectively analyzed the first 50 consecutive procedures for benign prostatic hyperplasia at a Taiwanese tertiary center. Institutional chronological case number was modeled continuously with preoperative prostate-volume adjustment and heteroskedasticity-robust inference. Outcomes were total operative time and planning, waterjet, and adjunct phases. Three-knot restricted cubic splines examined nonlinearity; sensitivity analyses restricted the cohort to the dominant surgeon and adjusted for anatomical case mix. Mean total time was 64.8 ± 23.6 min; planning, waterjet, and adjunct times were 22.4 ± 7.4, 5.8 ± 2.4, and 36.6 ± 15.8 min. Adjusted linear case-number coefficients were - 0.513, - 0.336, - 0.047, and - 0.130 min/case, respectively. The total-time 95% confidence interval was - 0.759 to - 0.267; the adjunct interval was - 0.311 to 0.050 (p = 0.152). Inverse total, planning, and waterjet associations persisted in sensitivity analyses. Adjunct spline associations were significant overall (p = 0.028) and for nonlinearity (p = 0.009). Six patients (12%) had postoperative complications; four underwent reintervention under general anesthesia and two received transfusions, with overlapping events. Postoperative functional and imaging findings were exploratory available-case outcomes. Institutional workflow maturation was clearest in planning and the composite waterjet phase. Adjunct finishing remained the largest component and showed an exploratory nonlinear chronological association.