Introduction: We report our clinical experience with Aquablation with endoscopic evaluation at 3 months and 1 year after the procedure and perioperative and 2-year functional outcomes. Methods: In this prospective study, with enrolment from 10/2018 to 10/2020, the inclusion criteria were patients with BPH-related LUTS, International Prostate Symptom Score (IPSS) =10, prostate volume <80 mL and maximum micturition rate (Qmax) =12 mL/s. Demographic data, perioperative data and complications (according to the Clavien-Dindo system) were collected. Functional outcomes were assessed at 1, 3, 6, 12 and 24 months with uroflowmetry, post-void residual assessment (PVR), IPSS, Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire for ejaculatory dysfunction (MSHQ-EjD). In addition, patients underwent cystoscopy at 3 and 12 months after the surgical procedure to evaluate the quality of the ablation was assessed according to a Likert scale (1-poor; 5-excellent). In addition, the preservation of the veru montanum, the presence of residual fluffy tissue or mucosal flaps and ureteral orifices, and the presence of scar tissue at the level of the bladder trigone were assessed. Results: 56 patients were enrolled in the study. Preoperative median Qmax, IPSS, QoL score and mean PVR were respectively 8 (2,4) ml/s, 22 (16-28), 4 (3-5) and 76 (9,8) ml. The median ablation time was 5.12 (2.13) min. The median catherization time and hospital stay were 3 (3-4) and 4 (4-5) days, respectively. We recorded 3 postoperative complications classified as Clavien-Dindo grade > 2 (5.3%), namely 1 (1.7%) acute urinary retention after catheter removal and 2 (3.5%) anemia requiring transfusion. At 3-month and 12-months follow-up cystoscopy in 15/56 (26.7%) patients non-obstruent mucosal flap was shown, but no damage to the verumontanum as well as no residual fluffy tissue, ureteral orifices or bladder trigone were recorded. The median quality of the ablation was 3 (3-4). The median IPSS urinary symptom score was 4 (2-6) after 1 month and further improved to 2 (1-4) two year after surgery. Concurrently, the median IPSS QoL score and mean PVR reached 0 (0-1) and 18,9 ml (22,7) at 24 months. The mean Qmax was 19.7 (9.3), 18.1 (3.1), 18.2 (6.2), 17.5 (6.1) and 18.1 (6.6) ml/s at 1, 3, 6, 12 and 24 months, respectively. No patients developed postoperative erectile dysfunction, while 3 (5,4%) reported loss of antegrade ejaculation. Conclusions: Endoscopic and functional results demonstrate that Aquablation is a safe, feasible and effective procedure for the treatment of BPH-related LUTS up to 2 years follow up. SOURCE OF Funding: None
