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Comparative Study
. 2024 May 9;42(1):306.
doi: 10.1007/s00345-024-04997-0.

Aquablation versus HoLEP in patients with benign prostatic hyperplasia: a comparative prospective non-randomized study

Jakob Michaelis  1 , Max Träger  1 , Sophie Astheimer  1 , Moritz von Büren  1 , Elfi Gabele  1 , Markus Grabbert  1 , Jan Halbich  1 , Marius Kamps  1 , Jonas Klockenbusch  1 , Theresa Noll  1 , Phillippe Pohlmann  1 , Daniel Schlager  1 , August Sigle  1 , Martin Schönthaler  1 , Konrad Wilhelm  1 , Christian Gratzke  1 , Arkadiusz Miernik  1 , Dominik Stefan Schöb  2
Affiliations
Comparative Study

Aquablation versus HoLEP in patients with benign prostatic hyperplasia: a comparative prospective non-randomized study

Jakob Michaelis et al. World J Urol. .

Abstract

Purpose: The question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort.

Methods: Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume ("PV"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo ("CD") classification.

Results: We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation's results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01).

Conclusions: While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.

Keywords: Aquablation; BPS; Endourology; HoLEP.

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Conflict of interest statement

All authors declare that there is no conflict of interest and gave their consent for publication.

Figures

Fig. 1
Fig. 1
Perioperative characteristics
Fig. 2
Fig. 2
Objective outcomes at baseline (BL) and at follow-up examinations at three months postoperative (3M_p), six months postoperative (6M_p) and 12 months postoperative (12M_p), respectively. PV was measured via transrectal sonography (a), uroflowmetric outcomes are reported as maximum urinary flow rate (b) with sonographic evaluation of post-void residual volume afterwards (d). PSA values are measured as serum levels by chemiluminescence immunoassay (c)
See this image and copyright information in PMC

Comment in

References

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