Open Access

ARTICLE

Aquablation with subsequent selective bipolar cauterization versus holmium laser enucleation of the prostate (HoLEP) with regard to perioperative bleeding

Simon Gloger¹, Leon Schueller¹, Laszlo Paulics¹, Thorsten Bach², Burkhard Ubrig¹

1 Center for Minimally Invasive and Robotic Urology, Augusta Bochum, Witten/Herdecke University, Germany
2 Department of Urology, Asklepios Hospital Harburg, Hamburg, Germany
Address correspondence To Dr. Simon Gloger, Augusta Hospital Bochum, Center for Minimally Invasive and Robotic Urology, Witten/Herdecke University, Bergstraße 26, 44791 Bochum, Germany

Canadian Journal of Urology 2021, 28(3), 10685-10690.

Abstract

Introduction: To compare the surgical methods of Aquablation followed by selective hemostasis by bipolar cauterization with holmium laser enucleation of the prostate (HoLEP) with regard to the risk of perioperative bleeding complications.
Materials and methods: A retrospective comparison was carried out on a total of 382 patients who had undergone either Aquablation (n = 167) or HoLEP (n = 215) at our hospital between April 2018 and July 2020. The following were studied: Hb loss, the need for packed red blood cell transfusions, and surgical revisions due to bleeding from the prostatic fossa.
Results: Transfusions were not necessary in the Aquablation group, while one man who underwent HoLEP had to receive a transfusion. Revision surgery due to bleeding was necessary during the early postoperative course in 13.2% of Aquablations and in 9.8% of HoLEPs (statistically not significant; p = 0.329). The perioperative Hb loss was comparable in both entire collectives (Aquablation 1.37 ± 1.13 mg/dL, HoLEP 1.22 ± 1.03 mg/dL; statistically not significant; p = 0.353). For subgroup analysis, the groups Aquablation and HoLEP were into three subgroups respectively according to sonographically determined preoperative prostate volume (“small” < 40 mL, “medium” 41-80 mL, “large” > 80 mL). There were no significant differences between the subgroups regarding need for transfusions and hematuria-related complications.
Conclusions: The rate of perioperative hematuria-related complications of Aquablation with subsequent selective hemostasis equals those found after holmium laser enucleation.

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