The combination of waterjet ablation (Aquabeam(®)) and holmium laser power for treatment of symptomatic benign prostatic hyperplasia: early functional results

INTRODUCTION: The aim of this study was to assess the short-term functional outcomes and the efficacy of hemostasis performed with holmium laser performed following prostatic hydroablation with the Aquabeam(®) system. MATERIAL AND METHODS: Between June 2019 and July 2020, 53 consecutive patients underwent Aquabeam(®) with our modified hemostasis approach with holmium laser. The following standard preoperative assessments were retrospectively recorded: prostate volume; International Prostate Symptom Score (IPSS) and Quality of Life (IPSS-QoL); uroflowmetry including Qmax and post void residual volume (PVR). RESULTS: Fifty-three patients consecutively underwent aquablation and holmium laser hemostasis. Median age at surgery, median prostate-specific antigen (PSA) and median prostate volume were 62 years (IQR: 57–66), 2.95 ng/ml (IQR: 1.6–4.8) and 55 ml (IQR: 43–65), respectively. Median operative time was 60 minutes (IQR: 40–80). Median catheterization time and length of hospital stay were 2 days (IQR: 1–3) for both parameters. The median hemoglobin decrease between the preoperative values and those assessed on the second day was equal to 1.25 g/dl (IQR: 0.7–1.85). Continence rate was 100% at catheter removal. Thirty-six patients (72%) reported anterograde ejaculation preservation. IPSS (6, 3–21) and Qmax (19, 9–26) changed dramatically between baseline and 3 months follow-up. CONCLUSIONS: The combination of Aquabeam(®) and holmium laser energy for hemostasis is a safe, reproducible technique to relieve moderate lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) while preserving ejaculation in younger and sexually active individuals. The short-term results showed a lower rate of complications; the encouraging functional results confirm that this can be a valid surgical approach for treatment of BPH.