Efficacy, feasibility, and safety of aquablation after previous urolift treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia: a retrospective cohort study.

Purpose: The influence of a previous Urolift treatment on the outcomes of prostate Aquablation is still controversial. This retrospective cohort study aimed to evaluate the perioperative outcomes, efficacy, feasibility, and safety of Aquablation after previous Urolift treatment.

Methods: The charts of patients with benign prostate hyperplasia (BPH) complicated by storage and voiding symptoms, who were previously treated with Urolift followed by Aquablation between January 2022 and July 2024, were retrospectively reviewed and analyzed for changes in International Prostate Symptom Score (IPSS), maximum urinary flow rates (Qmax), and postvoid residual volume (PVR) from baseline (pre-Aquablation) to the mean of three months postoperatively. Day-case surgery was performed in 75% of the cases.

Results: The study included 40 patients with a mean age of 68 (SD ± 8.91) years with moderately enlarged prostates (mean volume 81.56 mL, (SD ± 25.32), and median PSA 3.2 ng/dL). Five patients were presented initially with an indwelling Foley catheter, so their data were not included in the statistical analysis. After Aquablation, the mean IPSS improved from 24.7 (SD ± 7.63) at baseline to 9.8 (SD ± 2.55) (p < 0.0001), the mean Qmax increased from 9.6mL/sec (SD ± 5.76) at baseline to 20.8mL/sec (SD ± 6.28) (p < 0.0001), and the mean PVR decreased from 143mL (SD ± 104.89) at baseline to 36mL (SD ± 30.63 ) (p < 0.0001). The hospital stay for patients admitted ranged from 1 to 2 days. Moreover, there were no major intraoperative difficulties removing dislodged Urolift clips with a loop resectoscope at the end of the procedure, while non-dislodged clips were left in situ. None of the patients had postoperative bleeding that required hospital admission or blood transfusion following discharge.

Conclusion: Based on these results, prostate Aquablation appeared to be an effective, safe, feasible, and reliable surgical procedure for BPH patients who have had previous Urolift treatment. Further prospective and larger scale studies are needed.