Can Aquablation treatment help to effectively reduce the long waiting list of patients with surgical indication for benign prostatic obstruction in a fully public healthcare system? Results of the first 100 cases from a single-center same-operator cohort

Purpose To assess the efficacy and safety of Aquablation treatment in a single-center same-operator cohort and its potential role in reducing the long waiting list of patients with surgical indication for benign prostatic obstruction (BPO). Materials and methods Patients with surgical indication for BPO underwent Aquablation. All patients were treated by the same operator (D.P.) in a single center (Sant’Anna hospital, Como, Italy). Ablation was performed according to the standardized technique and coagulation through bipolar resectoscope was done in all cases. Perioperative parameters, functional outcomes and complications were assessed. Results 100 consecutive patients were included. Mean prostate size was 90.9 ml (min 40 ml, max 300 ml). Mean total operative time was 38.7 min, with a mean ablation time of 14.3 min and coagulation time of 21.8 min. No intraoperative complications were reported. In 2 cases a technical problem occurred and solved by replacing the handpiece. Postoperatively, 3 patients (3.0%) underwent urinary retention without haematuria, 2 patients (2.0%) underwent clots-induced retention, 1 patient (1.0%) developed an infection. No urethral strictures, nor bladder neck sclerosis were diagnosed during the follow-up, as well as no cases of stress urinary incontinence. Functional outcomes significantly improved compared to the preoperative evaluation. Conclusions Aquablation proved to be not only a fast treatment when performed by the same hands, but also a reliable option in terms of efficacy and safety, with good functional outcomes and very low complication rates. The shorter operative time provided by this technique may help to reduce the long waiting list of BPO patients with surgical indication.