Aquablation, a safe technique?

Introduction: Prostatic Aquablation has emerged as a minimally invasive treatment for benign prostatic hyperplasia, recognized in the European guidelines. The aim of this study is to evaluate the safety of the procedure in patients treated with this technique at a tertiary care hospital. Material and methods: Complications during hospitalization were evaluated, as well as the reasons for emergency visits and the medium-long-term complications in patients who underwent Aquablation between February 2021 and November 2024. Clinical and laboratory variables were also assessed, along with the type of complication, using the Clavien-Dindo classification system. Results: One hundred and ninety-two patients were operated on with Aquablation in a third-level hospital, between February 2021 and November 2024. Mean age of patients was 68.11 ±11.15 years. Mean prostatic volume was 76.58 ±26.46 ml. During the hospital stay, 30 patients (15.7%) presented some kind of complication. The main complication was haematuria requiring haemostatic resection (7 patients; 23.3%) or evacuation of clots by bladder washings (14 patients, 46.6%). Seven patients required blood transfusions. Two patients (6.66%) presented with acute urinary retention after urinary catheter removal. Additionally, two patients developed urinary tract infection during hospitalization. Two patients presented a rectal perforation. One patient presented a vesical perforation during surgery, and one of them had a false urethral passage. One patient died during hospitalization due to bronchoaspiration in the context of decompensation of multiple myeloma. Out of the total 126 patients who completed at least one year of follow-up, 10.31% (13 patients) required reintervention. Conclusions: Despite being a robotic treatment, Aquablation is not free of serious complications and requires a learning curve. Further studies are needed to properly establish the safety profile of this procedure.