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

• Published in: World journal of urology Vol. 42; no. 1; p. 306
• Main Authors: Michaelis, Jakob, Träger, Max, Astheimer, Sophie, von Büren, Moritz, Gabele, Elfi, Grabbert, Markus, Halbich, Jan, Kamps, Marius, Klockenbusch, Jonas, Noll, Theresa, Pohlmann, Phillippe, Schlager, Daniel, Sigle, August, Schönthaler, Martin, Wilhelm, Konrad, Gratzke, Christian, Miernik, Arkadiusz, Schöb, Dominik Stefan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 09-05-2024; Springer Nature B.V
• Subjects: Ablation Techniques - methods; Aged; Ejaculation; Enucleation; Humans; Hyperplasia; Laser Therapy - methods; Lasers, Solid-State - therapeutic use; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Original Article; Prospective Studies; Prostate; Prostatectomy - methods; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - surgery; Treatment Outcome; Urinary tract; Urology; Water; Endourology; HoLEP; BPS; Aquablation
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-024-04997-0

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.