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AUA2023 BEST POSTERS The Impact of Previous Benign Prostatic Hyperplasia Surgery on Robotic Waterjet Ablation Therapy
By: Randall A. Lee, MD, Keck School of Medicine, University of Southern California, Los Angeles; Giovanni Cacciamani, MD, Keck School of Medicine, University of Southern California, Los Angeles; Alireza Ghoreifi, MD, Keck School of Medicine, University of Southern California, Los Angeles; David Ortega Herrera, MD, Keck School of Medicine, University of Southern California, Los Angeles; Michael Eppler, BA, Keck School of Medicine, University of Southern California, Los Angeles; Abhisek Venkat, MD, Keck School of Medicine, University of Southern California, Los Angeles; Marissa Maas, MD, Keck School of Medicine, University of Southern California, Los Angeles; Lizana Maria, MD, Keck School of Medicine, University of Southern California, Los Angeles; Leo Duomanian, MD, Keck School of Medicine, University of Southern California, Los Angeles; Rene Sotelo, MD, Keck School of Medicine, University of Southern California, Los Angeles; Andre Abreu, MD, Keck School of Medicine, University of Southern California, Los Angeles; Mike Nguyen, MD, Keck School of Medicine, University of Southern California, Los Angeles; Inderbir Gill, MD, Keck School of Medicine, University of Southern California, Los Angeles; Mihir Desai, MD, Keck School of Medicine, University of Southern California, Los Angeles | Posted on: 30 Aug 2023
The incidence of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms has markedly increased over the years, with resultant expansion in surgical treatment options. As life expectancy continues to rise, patients undergoing surgical intervention for BPH are subject to possible tissue regrowth and treatment failure. Patients with previous intervention often present with variant anatomy, increasing the risk of subsequent intervention. A paucity of literature exists on the optimal treatment modality in patients who have failed previous BPH intervention.
Since its introduction in 2018, aquablation for lower urinary tract symptoms secondary to BPH has expanded its indications.1 Aquablation utilizes real-time ultrasonography for robotically executed waterjet ablation.1,2 Given the precise planning with ultrasound, we hypothesized that aquablation in previously treated patients is a safe and effective option in patients with previous BPH surgical history.
A prospectively managed, single institutional database of patients with BPH managed with aquablation was queried from August 2020 to June 2022 for patients who had a past surgical history of BPH procedure. Perioperative outcomes (operative time, estimated blood loss [EBL], hospital length of stay, catheter duration), complications, and functional outcomes (International Prostate Symptom Score) were compared in patients with vs without prior BPH surgery.
A total of 146 patients with BPH presented for management with aquablation. We identified 17 patients with a history of previous BPH procedures with median time since last intervention of 5.5 years (see Figure). A comparison of preoperative patient characteristics revealed no significant differences, except for preoperative prostate size. Patients who underwent previous BPH procedures had smaller prostate volumes (88.7 vs 69.7 cc, P = .01). Similarly, on comparison of perioperative outcomes there was no significant difference in operative time (63.8 vs 68 minutes, P = .6), EBL (40.2 vs 38.8 cc, P = .9), length of stay (1.3 vs 1.05 days, P = .2), or catheter duration (4 vs 4.1 days, P = .3). Additionally, we observed no difference in 90-day postoperative complications and no difference in pre- or postoperative functional outcomes between cohorts (see Table). Regardless, patients with and without previous intervention both experienced overall improvements in International Prostate Symptom Score (51.2% and 22.5% reduction, respectively).
Table. Characteristics and Perioperative Outcomes
| No history of intervention | History of intervention | P value | |
|---|---|---|---|
| Age, y | 68.8 | 69.7 | .5 |
| Preoperative medications, No. (%) | .5 | ||
| Alpha blocker | 53 (43.2) | 7 (10) | |
| 5-Alpha reductase inhibitor | 10 (6.8) | 2 (16.7) | |
| Both | 40 (27.4) | 4 (9.1) | |
| Prostate volume, cc | 88.6 | 69.8 | .01 |
| Estimated blood loss, cc | 40.1 | 38.7 | .9 |
| Operative time, min | 63.8 | 68 | .6 |
| Length of stay, d | 1.3 | 1.05 | .2 |
| Foley catheter time, d | 4 | 4.1 | .3 |
| 90-day complications, No. (%) | 40 (33.6) | 1 (7.1) | .06 |
| Preoperative IPSS | 21.2 | 24.4 | .2 |
| Abbreviations: IPSS, International Prostate Symptom Score. | |||
To our knowledge, we present the first series comparing patients with a history of BPH intervention undergoing aquablation. We observed no significant differences in perioperative outcomes, including EBL, hospital length of stay, catheter duration, and 90-day complications. Our experience highlights the safety of aquablation as a treatment option for patients who have failed BPH intervention. The utilization of ultrasound for systematic planning for execution of efficient tissue resection, without the risk of injury, makes aquablation an appropriate treatment option following failed BPH procedures.
- Nguyen DD, Misraï V, Bach T, et al. Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol. 2020;38(12):3227-3233.
- Nguyen DD, Barber N, Bidair M, et al. WATER versus WATER II 2-year update: comparing aquablation therapy for benign prostatic hyperplasia in 30-80-cm. Eur Urol Open Sci. 2021;25:21-28.
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