Aquablation versus HoLEP: Propensity score matching analysis of functional outcomes and ejaculation preservation.

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Investigative and Clinical Urology Pub Date : 2025-09-01 DOI:10.4111/icu.20250055

Kyung Tak Oh, Jang Hwan Kim

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Abstract

Purpose: This study aimed to compare the clinical outcomes of Aquablation and Holmium Laser Enucleation of the Prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH), with emphasis on functional improvement, ejaculatory preservation, and perioperative safety.

Materials and methods: We retrospectively analyzed data from January 2023 to March 2024, excluding patients with follow-up shorter than 3 months. Propensity score matching was performed using age, prostate volume, and preoperative prostate-specific antigen (PSA). Pre- and postoperative outcomes included International Prostate Symptom Score, Overactive Bladder Symptom Score, maximum flow rate (Qmax), post-void residual urine volume (PVR), PSA, and MSHQ-EjD (Male Sexual Health Questionnaire-Ejaculatory Dysfunction)-based ejaculatory grading (0-3). Paired t-tests, Wilcoxon signed-rank tests, McNemar's test, and Mann-Whitney U test were applied as appropriate.

Results: A total of 104 patients were included, with 34 matched pairs. Both procedures significantly improved lower urinary tract symptoms, with no significant differences in symptom score changes or PVR. HoLEP resulted in greater improvements in Qmax and PSA (p=0.011 and p<0.001, respectively). Aquablation demonstrated significantly better preservation of ejaculation (p=0.002). Although transient incontinence was more frequent in HoLEP and gross hematuria and urinary retention were more common in Aquablation, none of the complication rates showed statistically significant differences.

Conclusions: Aquablation and HoLEP are both effective surgical options for BPH. Aquablation offers comparable symptom relief with significantly superior ejaculation preservation, making it particularly suitable for sexually active patients. HoLEP provides greater deobstructive efficacy, as evidenced by superior Qmax and PSA outcomes. These findings support individualized, patient-centered decision-making.

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水消融与HoLEP：功能结果和射精保存的倾向评分匹配分析。

目的：本研究旨在比较水溶消融术和钬激光前列腺去核术（HoLEP）治疗良性前列腺增生（BPH）的临床效果，重点是功能改善、射精保存和围手术期安全性。材料和方法：回顾性分析2023年1月至2024年3月的数据，排除随访时间短于3个月的患者。使用年龄、前列腺体积和术前前列腺特异性抗原（PSA）进行倾向评分匹配。术前和术后结果包括国际前列腺症状评分、膀胱过度活动症状评分、最大尿流率（Qmax）、空后残余尿量（PVR）、PSA和基于MSHQ-EjD（男性性健康问卷-射精功能障碍）的射精评分（0-3）。配对t检验、Wilcoxon sign -rank检验、McNemar检验、Mann-Whitney U检验。结果：共纳入104例患者，配对组34对。两种方法均可显著改善下尿路症状，但在症状评分改变或PVR方面无显著差异。HoLEP对Qmax和PSA有较大改善（p=0.011和p）。结论：水溶消融术和HoLEP都是治疗BPH的有效手术选择。水消融提供了相当的症状缓解，显着优越的射精保存，使其特别适合性活跃的患者。HoLEP提供了更大的去梗阻效果，Qmax和PSA结果均较好。这些发现支持个性化的、以病人为中心的决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Investigative and Clinical Urology Medicine-Urology

CiteScore

4.10

自引率

4.30%

发文量

审稿时长

4 weeks

期刊介绍： Investigative and Clinical Urology (Investig Clin Urol, ICUrology) is an international, peer-reviewed, platinum open access journal published bimonthly. ICUrology aims to provide outstanding scientific and clinical research articles, that will advance knowledge and understanding of urological diseases and current therapeutic treatments. ICUrology publishes Original Articles, Rapid Communications, Review Articles, Special Articles, Innovations in Urology, Editorials, and Letters to the Editor, with a focus on the following areas of expertise: • Precision Medicine in Urology • Urological Oncology • Robotics/Laparoscopy • Endourology/Urolithiasis • Lower Urinary Tract Dysfunction • Female Urology • Sexual Dysfunction/Infertility • Infection/Inflammation • Reconstruction/Transplantation • Geriatric Urology • Pediatric Urology • Basic/Translational Research One of the notable features of ICUrology is the application of multimedia platforms facilitating easy-to-access online video clips of newly developed surgical techniques from the journal''s website, by a QR (quick response) code located in the article, or via YouTube. ICUrology provides current and highly relevant knowledge to a broad audience at the cutting edge of urological research and clinical practice.