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Early Complications After BPH Interventions: A Prospective Comparative Study of TURP,HoLEP,Aquablation, and PAE
Julian Giakas, MD, Thaise Sestelo Uzeda, MD, Ra'ad Al-Faouri, MD, Andrew Williams, MD, Jaleta Ahmed, MPH, Christian Schaufler, MD, Michelleq Shabo, MD, Eric MacDonald, MD, Shaun Wason, MD, Ruslan Korets, MD, Heidi J. Rayala, MD, PhD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
BACKGROUND: Urinary tract infections (UTI), hematuria, and catheter-dependence are common early complications following benign prostatic hyperplasia (BPH) interventions. The first postprocedural month represents the most variable and clinically challenging recovery period, yet prospective data comparing contemporary treatment modalities remain limited. This study evaluated the incidence of these complications across TURP, HoLEP, Aquablation, and prostate artery embolization (PAE) during the first postprocedural month.
METHODS: This multi-center, prospective study enrolled patients undergoing procedural treatments for BPH. UTI, hematuria, and catheter status were assessed preprocedurally, at 2 weeks, and 1 month postprocedurally. Mixed-effect logistic regression evaluated UTI and hematuria over time. Hematuria models were additionally adjusted for anticoagulant/antiplatelet use.
RESULTS: At the time of interim analysis, 99 patients had been enrolled, with continued accrual ongoing. Post-procedure UTI rates decreased after TURP and Aquablation, although results were not significant. Most patients achieved catheter independence by 1 month, however 2 patients in the PAE group remained with an indwelling catheter. One had a pre-existing catheter, and the other developed delayed urinary retention more than two weeks after the procedure. Hematuria remained common at 1 month following resective procedures (TURP 42.9%, HoLEP 32.6%, Aquablation 21.4%) but was significantly lower after PAE (4.2%; p<0.001). Anticoagulant and antiplatelets use were not associated with increased hematuria rates at either time point (p=0.263 and p=0.772, respectively).
CONCLUSIONS: During the first post-procedural month, catheter dependence resolved in most patients. Hematuria persisted more frequently after resective groups and was significantly lower after PAE, irrespective of anticoagulation or antiplatelet use. This prospective, real-world data, provides clinically relevant benchmarks to better inform patient counseling regarding early recovery.
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