Combination Prostatic Artery Embolization Prior to Water-Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy: A Propensity Score Analysis

<b>Objectives:</b> To compare post-operative bleeding measures in patients who underwent prostatic artery embolization (PAE) prior to water-jet ablation (aquablation) vs. water-jet ablation alone. <b>Methods:</b> A retrospective review identified 145 patients treated with water-jet ablation for benign prostatic hyperplasia from December 2018 to June 2021. Patients were divided into two groups: water-jet ablation alone (n = 56) vs. pre-operative PAE and water-jet ablation (n = 89). Patient demographics, pertinent laboratory values, operative reports, and hospital courses were reviewed. <b>Results:</b> PAE was technically successful in all patients (n = 89), and all 89 patients underwent successful water-jet ablation within a median time of 2 days. Compared to water-jet ablation alone, pre-operative PAE resulted in a significant reduction in post-operative bleeding as measured via lower rates of continuous bladder irrigation, hemostatic measures, and hematuria. Pre-operative PAE was also associated with lower rates of post-operative urinary retention (odds ratio 17, <i>p</i> = 0.02) and less likely to require reoperation 30 days after the procedure (<i>p</i> = 0.003). There were no major PAE-related adverse events reported in the combination arm. <b>Conclusions:</b> Compared to water-jet ablation alone, pre-operative PAE resulted in fewer bleeding-related complications and urinary retention.