Robotic water jet ablation (Aquablation) to treat urinary retention in men with benign prostatic enlargement

BACKGROUND: Robotic water jet ablation (Aquablation) has been recently introduced as a novel ablative technique to treat benign prostatic obstruction. It can be performed in prostates of all sizes, and aims to minimize the sexual side effect seen with certain other bladder outlet obstruction (BOO) surgeries. Its efficacy has been demonstrated in men with bothersome lower urinary tract symptoms, but its use for urinary retention is not well-studied. We report outcomes of a large series of men with urinary retention treated with Aquablation.METHODS: A retrospective single-center series of all men treated with Aquablation between July 2022 and December 2023. Data were collected prospectively on age, indication for surgery, use of medication for benign prostatic obstruction (BPO), prostate volume, intravesical prostatic protrusion, operative time, perioperative complications, pre and postoperative serum hemoglobin levels, and catheter-free rates at 24 hours and 2 weeks postoperatively, and at final follow-up at 14 months. The primary endpoint was the catheter-free rate.RESULTS: A total of 114 men, with a mean age of 67 (47-87) were treated with Aquablation for lower urinary tract symptoms (LUTS) or urinary retention due to BPO, during the time period studied. Of these, 31 men were treated for urinary retention (mean age 68 years). The majority (23 patients) had AUR with a mean prostate volume of 104 cc (40-200). Catheter-free rates were 71% at initial TWOC, and 97% at 2 weeks, following surgery. The catheter-free rate remained at 97% at 14 months after surgery, and none of the patients have required further surgery for LUTS or retention. Two patients required return to theatre for hemostasis, and no patients required blood transfusion.CONCLUSIONS: Aquablation is an effective treatment for men with acute or chronic urinary retention, irrespective of prostate volume. Long-term catheter-free rates are 97%, with a low rate of peri-operative complications.