Open Access

ARTICLE

Focal bladder neck cautery associated with low rate of post-Aquablation bleeding

Dean S. Elterman¹, Susan Foller², Burkhard Ubrig³, Alexander Kugler⁴, Vincent Misrai⁵, Angelo Porreca⁶, Dominik Abt⁷, Kevin C. Zorn⁸, Naeem Bhojani⁸, Lewis Kriteman⁹, Rahul Mehan¹⁰, Michael McDonald¹¹, Steven A. Kaplan¹²

1 Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
2 Universitätsklinikum Jena, Jena, Germany
3 Witten/Herdecke University, Augusta-Kranken-Anstalt, Bochum, Germany
4 Klinikum Fichtelgebirge Marktredwitz gGmbH, Marktredwitz, Germany
5 Clinique Pasteur, Toulouse, France
6 Policlinico Abano Terme, Abano Terme PD, Italy
7 Kantonsspital St. Gallen, Switzerland
8 University of Montreal, Montreal, Quebec, Canada
9 Northside Forsyth Hospital, Atlanta, Georgia, USA
10 East Valley Urology Center, Mesa, Arizona, USA
11 AdventHealth Celebration, Celebration, Florida, USA
12 Mount Sinai Medical Center, New York, New York, USA
Address correspondence to Dr. Dean S. Elterman, Toronto Western Hospital, Main Pavilion, 8^th Floor, Room 317, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada

Canadian Journal of Urology 2021, 28(2), 10610-10613.

Abstract

Introduction: To determine if focal bladder neck cautery is effective in reducing bleeding following prostate tissue resection for benign prostatic hyperplasia using Aquablation.
Materials and methods: Consecutive patients from 11 countries in Asia, Europe, and North America who underwent Aquablation for symptomatic benign prostatic hyperplasia between late 2019 and January 2021 were included in the analysis. All patients received post-Aquablation non-resective focal cautery at the bladder neck.
Results: A total of 2,089 consecutive Aquablation procedures were included. Mean prostate size was 87 cc (range 20 cc to 363 cc). Postoperative bleeding requiring transfusion occurred in 17 cases (0.8%, 95% CI 0.5%-1.3%) and take-back to the operating room for fulguration occurred in 12 cases (0.6%, 95% CI 0.3%-1.0%). This result compares favorably (p < .0001) to the previously published hemostasis transfusion rate of 3.9% (31/801) using methods performed in the years 2014 to 2019.
Conclusions: In prostates averaging 87 cc in size (range 20 cc-363 cc), Aquablation procedures performed with focal bladder neck cautery that required a transfusion postoperatively occurred in a remarkably low number of cases.

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