Urologist La Paz University Hospital, Madrid, Spain
Introduction: Robotic prostatic hydroablation (AquaBeam®) is a novel technique for the surgical treatment of benign prostatic hyperplasia (BPH). The objective of this study is to compare perioperative morbidity and treatment efficacy of prostatic hydroablation and Holmium laser prostate enucleation (HoLEP). Methods: A total of 202 patients were analysed (101 by AquaBeam® and 101 by HoLEP) were analysed. A propensity score matching system was generated to obtain comparable cases from the HoLEP database at our institution. Patients included for analysis had undergone surgery in our department from April 2016 to October 2021. The following parameters where analysed: surgical time, haemoglobin (Hb) loss, length of stay, variation in Q -max, PSA, International Prostate Symptoms Score (IPSS), change in IPSS and in IPSS QoL, sexual function measured by the International Index of Erectile Function-5 item (IIEF-5), presence of ejaculation and perioperative morbidity. Median follow up was 12 months (IQR 12-36). Results: Preoperative parameters were comparable between both groups (including prostate size, p=0.548). The perioperative and follow-up variables are shown in the following Table. Variables Median (RIQ) / Media (DE) HoLEP (n=101) AquaBeam® (n=101) p Surgical time(min) 59(43-75) 45(40-57.5) <0,001 Length of hospital stay(días) 1(1-3) 3(2-3) 0.001 Hb loss(g/dl) 1.5(2.4) 2.5(1.5) 0.004 Postoperative IPSS 4.9(4.9) 9.3(6.8) <0,001 IPSS-QoL postop 1.0(1.2) 1.9(1.4) <0,001 Change in IPSS -18.4(4.1) -14.1 (3.2) 0,321 Change in IPSS-QoL 4(3-5) 5(2-5) 0,747 Postoperative Q-Max(ml/s) 30.0(13.0) 14.6(5.7) <0.001 Postoperative PSA(ng/dl) 0.9(1.4) 2.6(1.7) <0,001 Postoperative IIEF-5 13.3(8.1) 13.8(6.9) 0.733 Presence of ejaculation Normal: 0.01% Altered or absent: 99.9% Normal: 66.7% Altered or absent: 33.3% <0.001 No major differences in intraoperative complications were observed between both groups. With regards to postoperative complications, 17.3% vs 20.5% presented early urinary incontinence (AquaBeam® vs. HoLEP; p=0.62). 5 patients in the AquaBeam® group and 1 patient treated with HoLEP required blood transfusion (p=0.02). 2 patients treated with HoLEP and 5 with AquaBeam® required reoperation due to haematuria (p=0.03). 1 rectal perforation occurred and 1 patient died after a pneumonic process in the AquaBeam® group. Conclusions: Hydroablation surgery is an effective technique for patients with benign prostate hyperplasia. It offers good functional results whilst allowing the preservation of ejaculation. AquaBeam® presents a longer hospital admission mainly due to haematuria. The data presented compare our initial experience and learning curve with AquaBeam® with a well-established HoLEP technique in our department. Therefore, it must be regarded as preliminary. SOURCE OF Funding: None
