Recovery After Aquablation for Benign Prostatic Hyperplasia

Introduction to Aquablation

Aquablation is a robotic-assisted surgical procedure that uses high-velocity water jets to remove prostate tissue in patients with benign prostatic hyperplasia (BPH), requiring general anesthesia and involving transurethral placement of the robotic handpiece, water jet ablation of prostate tissue under ultrasound guidance, and hemostasis achieved via electrocautery or traction from a 3-way catheter balloon 1

Advanced age may be associated with longer recovery periods, according to the European Urology guidelines 2

Aquablation has demonstrated noninferior functional outcomes compared to Transurethral Resection of the Prostate (TURP) in patients with lower urinary tract symptoms (LUTS) and prostate volumes between 30-80 ml, with sustained improvements in International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum flow rate (Qmax) through 36 months, as supported by the European Association of Urology 1, 2
At 36 months, mean IPSS improvement of 11.0 points (50% from baseline) and QoL improvement of 49% from baseline have been reported, with similar maximum flow rate improvements compared to TURP at 12 months (10.3 vs. 10.6 mL/s) 1
Aquablation has been associated with fewer Clavien-Dindo grade 2 complications at 3 months (26% vs. 42%, p=0.015) and significantly lower rates of retrograde ejaculation (6% vs. 23%, p=0.002) and less sexual dysfunction (33% vs. 56% reporting worsening sexual function at 6 months, p=0.03) compared to TURP 1

Better preservation of erectile and ejaculatory function has been reported with Aquablation, as supported by the American Urological Association (AUA) guidelines 1, 3
The AUA has given Aquablation a Conditional Recommendation with Evidence Level Grade C, positioning it as one of several surgical options for BPH treatment, with men with moderate-to-severe LUTS due to BPH with prostate volumes between 30-80 ml considered suitable candidates 1, 2
Patients who prioritize preservation of sexual function may also benefit from Aquablation, according to the AUA guidelines 1, 3
The AUA does not classify Aquablation as a minimally invasive surgical therapy (MIST) due to the requirement for general anesthesia 1