We report our clinical experience with Aquablation in terms of perioperative and 1-year functional outcomes, along with 3- months and 1-year endoscopic evaluation after the procedure.

From 10/2018 to 09/2021, patients referred to our center with BPH-related LUTS, International Prostate Symptom Score (IPSS) ≥10, maximum urinary flow rate (Qmax) ≤12 mL/ s, and prostate volume <80 mL were enrolled in this prospective study to undergo Aquablation. Exclusion criteria were prostate cancer diagnosis, previous prostate surgery, indwelling catheter, urethral stenosis, bladder stones, prostatic calcifications. Demographics, perioperative data and complications (according to the Clavien–Dindo system) were collected. Functional outcomes were assessed at 1, 3, 6, and 12 months with IPSS, Sexual Health Inventory for Men (SHIM), Male Sexual Health Questionnaire for ejaculatory dysfunction (MSHQ-EjD), uroflowmetry and evaluation of post void residue (PVR). In addition, the patients underwent cystoscopy at 3 and 12 months after the surgical procedure. During the cystoscopy the presence of residual fluffy tissue or mucous flaps, the preservation of the veru montanum and the ureteral orifices as well as the presence of scar tissue at the level of the bladder trigone were evaluated. Moreover, the quality of the ablation at cystoscopy was rated according to a Likert scale (1-poor; 5-excellent).

68 patients were enrolled in the study, the mean BMI was 26.1. Before the surgery the median Qmax, IPSS, QoL score and mean PVR were respectively 8 (6-10), 22 (16-28), 4 (3-5) and 76 ml. The median ablation time was 5.12 (2.13) min. The median catherization time and hospital stay were 3 (3-4) and 4 (4-5) days, respectively. 13 postoperative complications were recorded (19.1%), of which 4 classified as Clavien-Dindo grade > 2 (5.9%), namely 2 (2.9%) anemization requiring transfusions, 2 (2.9%) acute urinary retention after catheter removal. The mean (SD) Qmax at 1, 3, 6 and 12 months was 20.2 (10.8), 17.7 (3.4), 18.3 (6.2) and 17.3 (6.1) ml/s, respectively. The median IPSS urinary symptom score was 5 (2-8) after 1 month and further improved to 2 (1-4) one year after surgery.

The median IPSS QoL score and mean PVR reached 1 (0-1) and 17 ml (5,6) at 12th month. No patients developed postoperative erectile dysfunction, while 2 (2.9%) reported loss of antegrade ejaculation. At 3-month follow-up cystoscopy, no residual fluffy tissue, as well as no damage to the verumontanum, ureteral orifices or bladder trigone were recorded. In 19/68 (27.9%) patients non-obstruent mucosal flap was shown. The median quality of the ablation was 3 (3-4). All these findings were confirmed at 12-months cystoscopy.

Ablation is a feasible, safe and effective procedure for the treatment of benign prostatic hypertrophy. This is demonstrated by endoscopic and functional results one year after the procedure.

Continence 2S2 (2022) 100415
DOI: 10.1016/j.cont.2022.100415