MP25-11 AQUABLATION OF THE PROSTATE

Abstract

INTRODUCTION AND OBJECTIVE: Aquablation of the prostate for the treatment of benign prostatic hyperplasia (BPH) has shown favorable efficacy and safety compared to transurethral resection of the prostate. The efficacy of Aquablation for larger prostates and those with median lobes makes it unique to other BPH treatments, which are limited by these metrics. Bleeding complications related to persistent hematuria is a risk of Aquablation. Herein, we propose a protocol to minimize bleeding that can be easily reproduced. METHODS: Retrospective review of patients undergoing Aquablation for BPH between February and September 2019 was performed. A standardized perioperative protocol (Figure 1) was implemented. Descriptive analysis summarizing perioperative outcomes was performed. Bivariable analysis using Fisher’s exact test was used to identify bleeding risk factors (Table 1). RESULTS: Thirty-two patients underwent Aquablation over the study period. All cases were performed without electrocautery under spinal anesthesia. Average preoperative IPSS was 20 (Range: 3 to 34) and Qmax was 7mL/s (Range: 0 to 11). Eight (25%) were catheter dependent prior to surgery. Fourteen (43.8%) had a median lobe. Mean prostate volume was 65 mL (Range: 30 mL to 200 mL). Average perioperative change in hemoglobin was 1.3 g/dL (Range: -0.3 g/dL to 4.2 g/dL). Nine (28.1%) experienced bleeding complications. Three (9.4%) required blood transfusions. Of the transfused patients, one had a preoperative hemoglobin of 7.9 and one required anticoagulation due to developing a DVT/PE. On Fisher’s exact test, prostate volume (91 mL vs 55 mL; p = 0.0361) and preoperative prostate specific antigen (6.6 vs 2.9; p = 0.0218) were associated with postoperative bleeding. CONCLUSIONS: We experienced a favorable perioperative hemoglobin trend compared to the literature with reduced postoperative catheter traction time and without use of electrocautery. Complications related to blood loss after Aquablation can be minimized by implementing our perioperative protocol.Source of Funding: None