The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia

<b><i>Objective:</i></b> Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. <b><i>Patients and Methods:</i></b> A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. <b><i>Results:</i></b> A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, <i>p</i> = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve <i>vs</i> 17% in the retreatment group, <i>p</i> = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] <i>vs</i> 2 [2-2] treatment-naïve, <i>p</i> = 0.037) and more additional procedures at follow-up (30% <i>vs</i> 8.3% treatment-naïve, <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.