Endoscopic and functional results after Aquablation for patients with benign prostatic hyperplasia: a primary experience in a tertiary care center.

De Cillis S1, Amparore D1, Sica M1, De Luca S1, Checcucci E2, Piana A1, Piramide F1, Volpi G1, Granato S1, Verri P1, Zamengo D1, Meziere J1, Quarà A1, Della Corte M1, Manfredi M1, Fiori C1, Porpiglia F1

Research Type

Clinical

Abstract Category

Prostate Clinical / Surgical

Abstract 441
Prostate & Urethra
Scientific Podium Short Oral Session 28
Saturday 10th September 2022
10:20 - 10:27
Hall K2
Benign Prostatic Hyperplasia (BPH) Conservative Treatment Male Surgery Clinical Trial
1. Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy., 2. Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy.
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Abstract

Hypothesis / aims of study
We report our clinical experience with Aquablation in terms of perioperative and 1-year functional outcomes, along with 3- months and 1-year endoscopic evaluation after the procedure.
Study design, materials and methods
From 10/2018 to 09/2021, patients referred to our center with BPH-related LUTS, International Prostate Symptom Score (IPSS) ≥10, maximum urinary flow rate (Qmax) ≤12 mL/ s, and prostate volume <80 mL were enrolled in this prospective study to undergo Aquablation. Exclusion criteria were prostate cancer diagnosis, previous prostate surgery, indwelling catheter, urethral stenosis, bladder stones, prostatic calcifications. Demographics, perioperative data and complications (according to the Clavien–Dindo system) were collected. Functional outcomes were assessed at 1, 3, 6, and 12 months with IPSS, Sexual Health Inventory for Men (SHIM), Male Sexual Health Questionnaire for ejaculatory dysfunction (MSHQ-EjD), uroflowmetry and evaluation of post void residue (PVR). In addition, the patients underwent cystoscopy at 3 and 12 months after the surgical procedure. During the cystoscopy the presence of residual fluffy tissue or mucous flaps, the preservation of the veru montanum and the ureteral orifices as well as the presence of scar tissue at the level of the bladder trigone were evaluated. Moreover, the quality of the ablation at cystoscopy was rated according to a Likert scale (1-poor; 5-excellent).
Results
68 patients were enrolled in the study, the mean BMI was 26.1. Before the surgery the median Qmax, IPSS, QoL score and mean PVR were respectively 8 (6-10), 22 (16-28), 4 (3-5) and 76 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. 13 postoperative complications were recorded (19.1%), of which 4 classified as Clavien-Dindo grade > 2 (5.9%), namely 2 (2.9%) anemization requiring transfusions, 2 (2.9%) acute urinary retention after catheter removal. The mean (SD) Qmax at 1, 3, 6 and 12 months was 20.2 (10.8), 17.7 (3.4), 18.3 (6.2) and 17.3 (6.1) ml/s, respectively. The median IPSS urinary symptom score was 5 (2-8) after 1 month and further improved to 2 (1-4) one year after surgery.
Interpretation of results
The median IPSS QoL score and mean PVR reached 1 (0-1) and 17 ml (5,6) at 12th month. No patients developed postoperative erectile dysfunction, while 2 (2.9%) reported loss of antegrade ejaculation. At 3-month follow-up cystoscopy, no residual fluffy tissue, as well as no damage to the verumontanum, ureteral orifices or bladder trigone were recorded. In 19/68 (27.9%) patients non-obstruent mucosal flap was shown. The median quality of the ablation was 3 (3-4). All these findings were confirmed at 12-months cystoscopy.
Concluding message
Ablation is a feasible, safe and effective procedure for the treatment of benign prostatic hypertrophy. This is demonstrated by endoscopic and functional results one year after the procedure.
Disclosures
Funding None. Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee San Luigi Gonzaga Orbassano Helsinki Yes Informed Consent Yes
Citation

Continence 2S2 (2022) 100415
DOI: 10.1016/j.cont.2022.100415

14/10/2024 23:59:58