Safety and Efficacy of Aquablation in Men 80 Years or Older: An analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) Real-World database

Purpose Aquablation is under-researched, especially in the elderly. As older patients face higher risks of surgical complications, this study aims to evaluate the safety and efficacy of Aquablation in octogenarians. Methods This retrospective, multi-center study includes 2,136 patients who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts, ≥ 80 and < 80 years of age, consisting of 206 and 1930 men, respectively. Data included baseline characteristics, operative characteristics, and post-operative functional outcomes. Peri-operative events were compared. Results Men ≥ 80 had higher rates of anxiety/depression (32% vs 16%, p = 0.0032), 5α-reductase inhibitor use (35% vs 19%, p = 0.0009), and anticoagulation (56% vs 24%, p < 0.0001). Mean prostate volume was similar between groups, but men ≥ 80 were less likely to have a median lobe (52% vs 63%, p = 0.003). Both groups showed similar improvements in peak urinary flow rate, post-void residual, International Prostate Symptom Score and quality of life. Men ≥ 80 had higher rates of take-back for cystoscopy/clot evacuation (4.4% vs 1.9%, p = 0.034), transfusions (2.9% vs 0.5%, p = 0.003) and 30-day readmissions (4.2% vs 0.7%, p = 0.002). Age and urinary retention were associated with a composite bleeding outcome. There were no changes in erectile function and no differences in retrograde ejaculation between groups. Conclusion This study is the first to assess Aquablation's safety and efficacy across all ages. Aquablation offers similar voiding improvements in men aged ≥ 80 as in younger men, with slightly higher perioperative risks. Thus, Aquablation should be considered for well-selected, elderly patients with significant BPH who wish to preserve sexual function.