Comparative Analysis of 30- and 90-Day Outcomes of Aquablation vs Other Surgical Treatments for Benign Prostatic Hyperplasia

<b><i>Background:</i></b> Short-term outcomes of Aquablation as the treatment for benign prostatic hyperplasia (BPH) have not been well characterized. The aim of this analysis was to compare rates of 30- and 90-day complications following Aquablation with those after transurethral resection of prostate (TURP), UroLift, holmium laser enucleation of the prostate (HoLEP), and laparoscopic simple prostatectomy (SP). <b><i>Methods:</i></b> Using the TriNetX Research database, a collaborative claims and electronic medical record research network of 79 large health care organizations, we conducted a propensity-matched retrospective cohort study of all patients who underwent Aquablation (Current Procedural Terminology [CPT] 0421T or Healthcare Common Procedure Coding System ((HCPCS) C2596), TURP (CPT 52601), UroLift (CPT 52441), HoLEP (CPT 52649), or laparoscopic SP (CPT 55866, 55867) between the dates of January 1, 2017, and December 31, 2023. We performed a propensity score matching for age at time of operation, diabetes, hypertension, obesity, and Prostate Specific Antigen (PSA) range to determine the relative risk of developing the following outcomes at 30- and 90-days postoperatively: visit to the emergency department, hospital readmission, catheter re-insertion, and urinary tract infection. <b><i>Results:</i></b> Prior to matching, data were available for 1054 Aquablation, 18,945 TURP, 3966 UroLift, 5200 HoLEP, and 5369 laparoscopic SP patients; 53% of Aquablation cases were performed in 2023. After matching Aquablation to each other procedure, the cohorts ranged in size from 1048 to 1054. At 30 and 90 days postoperatively, patients who underwent Aquablation were more likely to be readmitted to the hospital and require catheter re-insertion than most operative cohorts. When eliminating from the analysis patients who underwent Aquablation in 2023, the association between Aquablation and readmission did not persist. <b><i>Conclusions:</i></b> Patients undergoing Aquablation may experience higher rates of hospital readmission at 30 and 90 days postoperatively than most other surgical BPH cohorts, which may be because of the learning curve associated with the procedure or applying the procedure to larger prostate volumes.