RESUMEN
Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.
Asunto(s)
Técnicas de Ablación , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Resección Transuretral de la Próstata , Humanos , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Próstata/cirugía , Hiperplasia Prostática/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: The AUA guidelines for benign prostatic hyperplasia distinguish treatments based upon prostate volume (PV), particularly for very large prostates (> 150 mL). While the clinical outcomes and benefits of Aquablation have been studied for men with average and large prostates, it is unknown whether this technology can be used for very large prostates. MATERIALS AND METHODS: Men with PV > 150 mL undergoing Aquablation were identified retrospectively from four North American hospitals. The surgical times and clinical outcomes of men with very large prostates (> 150 mL) were compared to data from men with average PV ≤ 80 mL (WATER study) and large PV 80 mL-150 mL (WATER II study). RESULTS: The average PV of men who underwent Aquablation with very large prostates was 209 mL ± 56 (n = 34, range 151-362 mL), large PV 107 mL ± 20 (n = 101, range 80-150 mL) and average PV 54 mL ± 16 (n = 116, range 30-80 mL). For men with PV > 150 mL, baseline IPSS was 19 ± 6. With a mean follow up of 7 ± 9 months, the IPSS improved to 7 ± 5 (p < 0.001). Peak urinary flow rate, Qmax, improved from 7 ± 4 mL/s to 19 ± 5 mL/s (p<0.001). Compared to the two other PV groups, there were no differences in terms of improvements in IPSS, quality of life, or uroflowmetry. There were no reports of transfusions (0%) in the cohort of men with very large prostates. CONCLUSIONS: In the present study, we demonstrate that Aquablation is effective and safe in prostates greater than 150 mL while showing consistent outcomes compared to average and large prostates sizes.
Asunto(s)
Técnicas de Ablación , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Humanos , Síntomas del Sistema Urinario Inferior/complicaciones , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Próstata/cirugía , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento , AguaRESUMEN
INTRODUCTION To characterize procedure variables and outcome data from men undergoing the Aquablation Therapy of the prostate procedure for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). We evaluated the safety and efficacy of robotically guided waterjet-based prostate resection in the first study of all-comers in a single-center, commercial setting in the United States. MATERIALS AND METHODS: The analysis was a retrospective review of prospectively collected data. RESULTS: Fifty-five men underwent the Aquablation of the prostate between July 2018 and December 2019. Mean prostate volume was 100 cc, and 85% had a prominent, obstructing middle lobe. Operative time averaged 59 minutes, and the mean hemoglobin drop was 1 g/dL. A substantial improvement of 80% (17 points) was seen in BPH symptoms scores. By uroflowmetry, Qmax improved by 182% (14 mL/sec). Men with prostate volume > 100 cc had similar hospital length of stay, BPH symptom reduction, and Qmax improvement compared to those with volume < 100 cc. CONCLUSION: In the setting of a community private urology practice, Aquablation Therapy was safe and effective for the treatment of men with BPH regardless of prostate shape or prostate size.