Introduction: Aquablation has been previously reported with a 10% bleeding risk and a 6% requiring transfusion rate. The purpose of this study was to demonstrate the feasibility and safety of Prostatic Artery Embolization (PAE) before Aquablation® in patients with Benign Prostatic Hypertrophy (BPH). Methods: A retrospective chart review identified 148 patients treated with Aquablation® for BPH from May 2018 to June 2021. Patients were divided into two groups: Aquablation® alone (n=56) vs. combination PAE and Aquablation® (n=89). Patient demographics, pertinent laboratory values, operative reports, and the hospital courses between the two groups were reviewed. After propensity score matching for age and prostate gland size, outcomes were compared between Aquablation alone vs combination therapy. Results: PAE was technically successful in 89/89(100%) combination patients and all 89 patients underwent successful Aquablation® within a median time of 2 days. Compared to Aquablation® alone, PAE prior resulted in significant reduction in hospital length of stay (34.4 ± 23.5 vs 13.8 ± 26.1 hours, p < 0.001). Additionally, PAE before Aquablation® resulted in 16 times (P=0.001) less likely use of perioperative hemostatic measures (balloon traction, cautery). Patients without prior PAE were 7.8 times more likely (p < 0.001) to require >2 hours of post-operative continuous bladder irrigation. Patients with Aquablation® alone were also more likely to return to the operating room within 30 days of the procedure (p < 0.001). Lastly, the incidence of persistent hematuria at 2 or 4 week followup was 3.2 times higher in the Aquablation® alone group (p < 0.001) compared to the combination group. There were no major PAE related adverse events reported in the combination arm. Conclusions: Combination PAE and Aquablation® resulted in a reduction in length of hospital stay, intraprocedural hemostastatic maneuvers, and less post-operative bleeding complications than patients undergoing Aquablation® monotherapy for treatment of BPH. SOURCE OF Funding: NA
