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CLINICAL AND FUNCTIONAL OUTCOMES FOLLOWING AQUABLATION: A FOUR-YEAR ANALYSIS
Daniel Pohl, MD, BA, Rachael Gotlieb, MD, Shannon McNAll, MD, Arthur Mourtzinos, MD.
Lahey Clinic, Burlington, MA, USA.
BACKGROUND: Aquablation is a robot-assisted, ultrasound-guided waterjet ablation technique designed to treat benign prostatic hyperplasia (BPH). As a relatively recent innovation, data on its efficacy and functional outcomes remain limited. We aimed to evaluate the clinical effectiveness of Aquablation by comparing preoperative and postoperative International Prostate Symptom Scores (IPSS) and postvoid residual (PVR) volumes.
METHODS: We retrospectively reviewed 151 patients who underwent Aquablation by a single surgeon at a high-volume center from April 2021- March 2025. We included patients with available data on pre- and post-operative IPSS, bother score, PVR, prostate size, age, use of pre-operative medications (e.g., alpha blockers), and complications. 60 patients met inclusion criteria. Wilcoxon signed-rank tests were used to analyze changes in the various metrics, adjusting for age, prostate size, pre-operative medications, baseline IPSS, bother score, and PVR using linear regression. Patients with incomplete data were excluded. 39 patients had data regarding ejaculation preservation.
RESULTS: The average age and average prostate size were 68 years and 95 grams, respectively. Mean IPSS score significantly decreased from 22.4 ± 6.1 preoperatively to 8.9 ± 5.0 postoperatively (p < 0.001) and bother score from 4.6 ± 1.2 to 1.8 ± 0.9 (p < 0.001). Mean PVR decreased from 120mL to 40 mL (p < 0.001). Improvements in all three metrics remained significant after adjusting for age, prostate size, preoperative medication status, and pre-operative IPSS, bother score and PVR. Only two post-operative complications occurred. Among the 39 patients for whom we had data on ejaculation, 74.3% of patients reported post-operative ejaculation preservation.
CONCLUSIONS: Aquablation is an effective means of treating enlarged prostates, significantly reducing symptom and bother scores, as well as PVRs, independent of age, prostate size, and pre-operative medication use. Continued follow-up is needed to assess long-term functional outcomes and complication profiles and to compare to alternative therapies.
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