LAUSR

Introduction Herein, we describe our initial experience performing waterjet ablation of the prostate without electrocautery. Methods A retrospective review of patients undergoing Aquablation for BPH between February and September 2019 was performed. A standardized perioperative protocol for optimizing hemostasis was implemented. The primary endpoint was to define bleeding complications perioperatively and up to 30 days postoperatively after Aquablation. Bleeding complications included hematuria requiring prolonged continuous bladder irrigation, drop in hemoglobin requiring transfusion, or take back to operating room for evacuation of bladder clots and bladder fulguration. Bivariable analysis using Fisher's exact test and unpaired t-tests were used to identify factors associated with bleeding complications. Results Thirty-two patients underwent Aquablation over the study period. Average preoperative IPSS was 20 (Range: 13 to 34) and Qmax was 7mL/s (Range: 0 to 11). Mean prostate volume was 65 mL (Range: 30 mL to 200 mL). Average perioperative change in hemoglobin was 1.3 g/dL (Range: -0.3 g/dL to 4.2 g/dL). Eight patients (25%) experienced bleeding complications. Three (9.4%) required blood transfusions. On Fisher's exact test, prostate volume (91 mL vs 55 mL; p = 0.0361) and preoperative prostate specific antigen (6.6 vs 2.9; p = 0.0218) were associated with postoperative bleeding. Conclusions Performing waterjet ablation of the prostate without the use of electrocautery after waterjet treatment to control bleeding resulted in significant bleeding complications (25% of our cohort) during our initial experience. A combination of traction and focal bladder neck electrocautery is the best strategy to minimize bleeding complications after Aquablation.